Spinal Subdural Hemorrhage in Abusive Head Trauma: A Retrospective Study

Choudhary, Arabinda K.; Bradford, Ray K.; Dias, Mark S.; Moore, Gregory J.; Boal, Danielle K.

doi:10.1148/radiol.11102390

Cited by 101 publications

(66 citation statements)

References 37 publications

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“…3,40,54 In infancy, excepting cases of abusive head injury, the rates of spinal injury associated with TBI have seemed to be quite low. 2,8,19,30 The current study reports spinal injury rates of 9.8% for NTDB admissions coded for TBI and 10.9% for admissions coded for GCS motor ≤ 4, but all spinal levels have been counted. Among admissions of patients whose clinical evaluations were obscured by intubation or sedation, the current study notes a prevalence of spinal injury of 16.7%.…”

Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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OBJECT In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury. METHODS Admissions for spinal fracture without or with spinal cord injury (SCI), spinal dislocation, and SCI without radiographic abnormality were identified in the Kids’ Inpatient Database (KID) and the National Trauma Data Bank (NTDB) registry for 2009. Patients ranged in age from birth up to 21 years. Data from the KID were used to estimate nationwide annual incidences. Data from the NTDB were used to describe patterns of injury in relation to age, race, and payor, with corroboration from the KID. Multiple logistic regression was used to model rates of mortality and spinal fusion. RESULTS In 2009, the estimated incidence of hospital admission for spinal injury in the US was 170 per 1 million in the population under 21 years of age. The incidence of SCI was 24 per 1 million. Incidences varied regionally. Adolescents predominated. Patterns of injury varied by age, race, and payor. Black patients were more severely injured than patients of other races as measured by Injury Severity Scale scores. Among black patients with spinal injury in the NTDB, 23.9% suffered firearm injuries; only 1% of white patients suffered firearm injuries. The overall mortality rate in the NTDB was 3.9%. In a multivariate analysis that included a large panel of clinical and nonclinical factors, black race retained significance as a predictor of mortality (p = 0.006; adjusted OR 1.571 [1.141–2.163]). Rates of spinal fusion were associated with race and payor in the NTDB data and with payor in the KID: patients with better insurance underwent spinal fusion at higher rates. CONCLUSIONS The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.

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Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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“…Although spinal subdural hematomas have been previously reported in nonaccidental head injury patients [1,2], the current case represents the first demonstration of a spinal epidural hematoma in these patients. Furthermore, spontaneous resolution of epidural hematomas is a rare event, with various hypotheses as to how this occurs [14,15,19].…”

Section: Discussionmentioning

confidence: 74%

“…Spinal subdural hematomas have been reported in the literature both in the setting of accidental and nonaccidental head trauma (domestic child abuse), with incidence rates ranging from 44 to 60% [1,2]. However, the incidence of spontaneous spinal epidural hematomas is very rare, with only 9 cases previously reported [3,4,5,6,7,8,9,10,11].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Resolution of Spinal Epidural Hematoma Resulting from Domestic Child Abuse: Case Report

Rangwala¹,

Birk²,

Tobin³

et al. 2016

Pediatr Neurosurg

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Nonaccidental head injury, as seen in domestic child abuse cases, is often associated with spinal injury, and spinal subdural hematoma is the most frequent diagnosis. While spinal epidural hematomas are a rare occurrence, the incidence of spontaneous epidural hematomas occurring in nonaccidental head injury patients is even lower. Epidural hematomas often result in acute focal neurological deficits necessitating emergent neurosurgical intervention. In patients without focal neurological deficits, conservative management may allow for spontaneous resolution of the epidural hematoma. The authors present the case of a 2-year-old boy with a large spinal epidural hematoma resulting after an event of nonaccidental injury, specifically, domestic child abuse. This patient exhibited no focal neurological deficits and was managed conservatively without surgical clot evacuation. On a follow-up visit, repeat imaging studies demonstrated a stable resolution of spinal epidural hematoma, providing further support for the safety of conservative management in these patients.

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“…A recent study found that more than 60% of children with abusive head trauma who underwent thoracolumbar imaging had subdural hemorrhage in the spinal canal. 5 Blunt abdominal trauma is caused by a direct blow or pressure to the underlying organs, causing contusion or laceration of the solid organs (eg, spleen, liver). However, as in our case, external bruises may not be evident, and indirect markers such as elevated liver enzymes or serum lipase can contribute to the diagnosis.…”

Section: Discussionmentioning

confidence: 99%