SDH and EDH in children up to 18 years of age—a clinical collective in the view of forensic considerations

Abstract

Providing concise proof of child abuse relies heavily on clinical findings, such as certain patterns of injury or otherwise not plausibly explainable trauma. Subdural hemorrhaging has been identified as a common occurrence in abused children whereas epidural hemorrhaging is related to accidents. In order to explore this correlation, we retrospectively analyzed clinical data of children under 19 years of age diagnosed with either injury. Reviewing 56 cases of epidural and 38 cases of subdural bleeding, it was shown that subdural bleeding is more common in young children and extremely often a result of suspected abuse in children under 2 years of age. Epidural hemorrhaging however never was found in the context of suspected abuse, was unrelated to other injuries typical for abuse, and did not see a statistically significant increase in any age group. In conformity with currently theorized mechanisms of injury for both types of bleeding, we found that subdural hemorrhaging in young children is closely associated with abuse whereas epidural bleeding is not.

Pediatric Head Traumas: A Different perspective

“…Early diagnosis and treatment is crucial for epidural hematoma. [15][16][17] Binder et al [8] reviewed 41 pediatric patients with traumatic epidural hematoma and they concluded that age, severity of trauma and neurological status are the main factors affecting the outcome of acute epidural hematoma in children. In our series, linear skull fracture was detected in 55 patients, while epidural hematoma in 15 patients, 13 of them underwent surgical treatment.…”

“…None of them died after surgery. Gekat et al [17] reviewed 56 cases of epidural and 38 cases of subdural hemorrhage and they showed that subdural hematoma is more common in young children and mostly the result of a suspected abuse in children under two years of age. Subdural hematomas may also be seen in children with head trauma.…”

Pediatric Abusive Head Trauma: A Systematic Review

“…Hung [11] Pediatric abusive head trauma X Yu et al [12] Injury patterns of child abuse: experience of two level 1 pediatric trauma centers X Mian et al [13] Shaken baby syndrome: A review X Schelhorn et al [14] Intracranial hemorrhage detection over time using susceptibility-weighted magnetic resonance imaging X Adamsbaum et al [15] Dating the abusive head trauma episode and perpetrator statements: Key points for imaging X X Wootton-Gorges et al [16] ACR appropriateness criteria ® suspected physical abuse-child X X Maguire et al [17] Retinal haemorrhages and related findings in abusive and non-abusive head trauma: A systematic review X X Vinchon et al [18] Confessed abuse versus witnessed accidents in infants: Comparison of clinical, radiological, and ophthalmological data in corroborated cases X Binenbaum et al [19] Retinal hemorrhage and brain injury patterns on diffusion-weighted magnetic resonance imaging in children with head trauma X X Christian et al [20] The eye examination in the evaluation of child abuse X Binenbaum et al [21] Patterns of retinal hemorrhage associated with increased intracranial pressure in children X Bhardwaj et al [22] A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma X Choudhary et al [23] Consensus statement on abusive head trauma in infants and young children X Elinder et al [24] Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking X Bradford et al [25] Serial neuroimaging in infants with abusive head trauma: Timing abusive injuries X X Agrawal et al [26] Prevalence of retinal hemorrhages in critically ill children X Gekat et al [27] SDH and EDH in children up to 18 years of age-A clinical collective in the view of forensic consideration X X Zuccoli et al [28] Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma X Mulvihil et al [29] An inter-observer and intra-observer study of a classification of RetCam images of retinal haemorrhages in children…”

“…Beavers et al reported 61% sensitivity for confirmed RH with simultaneous analysis of T2*-weighted, T2-weighted, FLAIR, T1-weighted, and T1-weighted contrast-enhanced sequences, with decreasing sensitivity of sequences in the order listed. They also correlated funduscopic severity and MRI detection rates and found that 76% of high-grade RHs were detected on MRI compared with only 14% of low-grade RHs [27].…”