Pediatric Abusive Head Trauma: A Systematic Review

Maiese, Aniello; Iannaccone, Francesca; Scatena, A; Fante, Zoe Del; Oliva, Antonio; Frati, Paola; Fineschi, Vittorio

doi:10.3390/diagnostics11040734

Cited by 30 publications

(24 citation statements)

References 61 publications

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“…Any nonverbal child with concerns for NAT should have detailed neurologic evaluation, which includes a dilated fundoscopic exam by an ophthalmologist, to rule out abusive head trauma (AHT). Several studies have suggested that retinal hemorrhages are among the most reliable clinical features/predictors of AHT – present in 78% of cases (compared with 5% of accidental head injuries) [40]. These hemorrhages are usually extensive, bilateral, multilayered, and extend to the outer edges of the retinal pole when compared with retinal hemorrhages from accidental trauma.…”

Section: Nonaccidental Traumamentioning

confidence: 99%

“…These hemorrhages are usually extensive, bilateral, multilayered, and extend to the outer edges of the retinal pole when compared with retinal hemorrhages from accidental trauma. Retinal hemorrhages have even been described in cases of AHT victims without radiographic signs of intracranial injury although this is rare [40,41]. Retinal hemorrhages and characteristic cutaneous features are key diagnostic components of the assessment of a child with NAT.…”

Section: Andandmentioning

confidence: 99%

See 1 more Smart Citation

The eyes have it: when skin findings prompt referral to ophthalmology

Dunn¹,

Foss²,

Kumar

2022

Current Opinion in Pediatrics

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Purpose of reviewCo-presentation of ocular and cutaneous conditions is common and prompt recognition of known associations may be imperative to sight-saving intervention. There are currently limited reviews in the pediatric literature addressing comorbid ocular and dermatologic presentations. Recent diagnostic and therapeutic advances have drastically altered the prognostic landscape for several disease states when recognition and referral are timely. The aim of this report is to examine important oculocutaneous disease associations with emphasis on management of ocular complications and appropriate referral practices to ophthalmology specialists. Recent findingsOculocutaneous associations can be broadly classified into four etiologic categories: infectious, inflammatory, genetic, and medication/nutrition induced pathology. Several conditions in all four categories have had recent advances in their etiologic understanding, diagnostic evaluation, and therapeutic approach. Thematically, these advances highlight increasing disease prevalence of certain conditions, previously unrecognized pediatric relevance of others, updated diagnostic criteria, and newer categories of iatrogenic illness induced by advances in medical therapy.

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Section: Nonaccidental Traumamentioning

confidence: 99%

Section: Andandmentioning

confidence: 99%

The eyes have it: when skin findings prompt referral to ophthalmology

Dunn¹,

Foss²,

Kumar

2022

Current Opinion in Pediatrics

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“…According to Korean legal judgments, children who exhibit the SBS triad are considered victims of abuse even without a witness or a confession [4]. However, Elinder et al [5] argued that it is reasonable to diagnose a patient with SBS even without clear evidence of the triad, and several other studies have supported this claim [6][7][8][9][10]. Hoskote et al [6] investigated the association between non-accidental head injury in children with acute SDH and five risk factors: (1) RH; (2) age < 12 weeks; (3) inconsistent history; (4) positive skeletal survey; and (5) unexplained bruising.…”

Section: Introductionmentioning

confidence: 99%

“…AHT also accounts for 95% of all serious intracranial injuries and 64% of all head injuries in children [9]. Additionally, the presence of severe neurological symptoms along with SDH and RH is strongly suggestive of AHT in the child [10].…”

Section: Introductionmentioning

confidence: 99%

Shaken Baby Syndrome and Accidental Traumatic Brain Injury: Characteristics and Effects on Legal Judgment

et al. 2023

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This study aimed to establish the medical evidence of abuse by comparing the clinical differences between children with shaken baby syndrome (SBS) who had no signs of trauma and traumatic brain injury (TBI). Methods: Children aged <5 years with intracranial hemorrhage (ICH) were divided into SBS group and TBI group, which was developed because of intentional or accidental trauma including physical violence. We investigated clinical characteristics, ICH and brain injury patterns, funduscopic examinations, and the legal consequences for guardians. Results: Compared to TBI, children with SBS had a higher incidence of neurological symptoms, including seizures (80.0% vs. 15.4%, P=0.001) and mental changes (73.3% vs. 32.5%, P=0.003); they also had a longer time to hospitalization (SBS, 21.8±30.4 hours; TBI, 9.5±21.3 hours; P=0.046). The rate of bilateral ICH was significantly higher in the SBS group (73.3% vs. 19.0%, P=0.001). In the TBI group, the incidence of epidural hemorrhage (EDH) and subdural hemorrhage was equal (42.3%), but EDH was not seen in the SBS group. Multistage ICH (58.3%) and diffusion-limiting lesions (75.0%) were common in SBS, with high mortality and neurological sequelae (86.7%). Nevertheless, only a few guardians (13.3%) were separated from the victim and only one person (6.7%) who confessed to abuse was detained. Conclusion: Children with SBS who have never been affected to external physical forces can have multistage and bilateral ICH with severe brain damage, which is clinically different from TBI. Our data suggest that adequate protection and active legal actions are required in order to protect children who had sufficient characteristics of SBS.

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“…Traumatic brain injury (TBI), on the other hand, designates physical damage to brain tissue resulting from a bump, a jolt, or a blow to the head for a direct impact or rapid acceleration–deceleration [ 12 , 13 , 14 , 15 , 16 ]. It represents a leading cause of death, long-term impairment, disability, and poor quality of life worldwide, affecting millions of people throughout the world every year [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Glymphatic System a Window on TBI Pathophysiology: A Systematic Review

Ferrara

Bertozzi

Volonnino

et al. 2022

IJMS

Self Cite

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Background: In recent years, the attention of the scientific world has focused on a clearance system of brain waste metabolites, called the glymphatic system, based on its similarity to the lymphatic system in peripheral tissue and the relevant role of the AQP4 glial channels and described for the first time in 2012. Consequently, numerous studies focused on its role in organ damage in cases of neuropathologies, including TBI. Methods: To evaluate the role that the glymphatic system has in the pathogenesis of TBI, on 23 March 2022, a systematic review of the literature according to PRISMA guidelines was carried out using the SCOPUS and Medline (via PubMed) databases, resulting in 12 articles after the selection process. Discussion and conclusion: The present review demonstrated that an alteration of AQP4 is associated with the accumulation of substances S100b, GFAP, and NSE, known markers of TBI in the forensic field. In addition, the alteration of the functionality of AQP4 favors edema, which, as already described, constitutes alterations of secondary brain injuries. Moreover, specific areas of the brain were demonstrated to be prone to alterations of the glymphatic pathway, suggesting their involvement in post-TBI damage. Therefore, further studies are mandatory. In this regard, a study protocol on cadavers is also proposed, based on the analyzed evidence.

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Pediatric Abusive Head Trauma: A Systematic Review

Cited by 30 publications

References 61 publications

The eyes have it: when skin findings prompt referral to ophthalmology

The eyes have it: when skin findings prompt referral to ophthalmology

Shaken Baby Syndrome and Accidental Traumatic Brain Injury: Characteristics and Effects on Legal Judgment

Glymphatic System a Window on TBI Pathophysiology: A Systematic Review

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