Understanding Subdural Collections in Pediatric Abusive Head Trauma

Abstract

Life-threatening physical abuse of infants and toddlers is frequently correlated with head injuries. A common variant of the abusive head trauma is the shaken baby syndrome. The present review article sheds light on subdural collections in children with abusive head trauma and aims at providing a recent knowledge base for various medical disciplines involved in diagnostic procedures and legal proceedings. To this end, the different subdural collection entities are presented and illustrated. The pathophysiologic background is explained. Differential and age-diagnostic aspects are discussed and summarized by tabular and graphic overviews. Two problematic constellations frequently occurring during initial CT investigations are evaluated: A mixed-density subdural collection does not prove repeated trauma, and hypodense subdural collections are not synonymous with chronicity. The neuroradiologic analysis and assessment of subdural collections may decisively contribute to answering differential diagnostic and forensic questions. In addition to more reference data, a harmonization of terminology and methodology is urgently needed, especially with respect to age-diagnostic aspects. ABBREVIATIONS: AHT ϭ abusive head trauma; BV ϭ bridging vein; cSDH ϭ chronic subdural hematoma; SDC ϭ subdural collection; SDE ϭ subdural effusion; SDH ϭ subdural hematoma; SDEm ϭ subdural empyema; SDHy ϭ subdural hygroma; SDHHy ϭ subdural hematohygroma I n light of serious physical, psychological, and legal consequences, physical child abuse attracts increasing attention in terms of health policy and health economy. 1-3 Head injuries represent the most frequent cause of lethal outcome and mainly relate to children within their first and second years of life. 4-6 Currently, the term "abusive head trauma" (AHT) is used for any nonaccidental or inflicted head injuries in pediatrics. 7-9 AHT has a worldwide incidence of 14-30/100,000 live births among children younger than 1 year of age. 5,10-13 Additionally, a high amount of underreporting has to be assumed because many cases are not identified due to subclinical courses, nonspecific symptoms, or missing medical consultation. 14 Meta-analyses on the outcome revealed an average mortality rate of around 20% among children younger than 2 years of age. 15 Survivors showed severe disability (eg, tetraplegia, epilepsy, or blindness) in ϳ34%,

Abusive head trauma in court: a multi-center study on criminal proceedings in Germany

“…On the one hand, detailed clinical diagnostics is frequently not performed before the death of a child occurring suddenly, thus impeding an adequate comparability of mere autopsy and clinical cases. On the other hand, the study cohort should intentionally comprise cases from the clinical routine, i.e., cases with the typical SBS/AHT findings that pediatricians, neurosurgeons, ophthalmologists, radiologists, or clinical forensic physicians are frequently confronted with [8,11,12,27,[30][31][32][33][34][35][36][37][38][39]. Hence, the present study cohort comprises cases with non-fatal outcome except for three.…”

Brückenvenenverletzungen bei Schütteltrauma

“…Subdurale Flüssigkeitsansammlungen – im internationalen Sprachgebrauch häufig verkürzt als „subdural collections“ (SDC) bezeichnet – stellen dabei die häufigsten Indikatoren des SBS/AHT dar [ 4 – 6 ]. Dabei handelt es sich um verschiedene, sich z. T. stadienartig entwickelnde Befunde innerhalb des unter physiologischen Bedingungen nichtexistenten Subduralraums, insbesondere subdurale Hämatome, Hygrome und Hämatohygrome [ 7 , 8 ]. Prognosebestimmend ist allerdings in der Regel nicht das Ausmaß der SDC, sondern der Grad der traumatischen Enzephalopathie als Ausdruck der gleichzeitigen Parenchymschädigung infolge von Scherverletzungen mit möglichen Einblutungen und möglicher Sekundärschädigung durch Hypoxie [ 2 , 3 ].…”

Examining perinatal subdural haematoma as an aetiology of extra‐axial hygroma and chronic subdural haematoma

“…This remains an ongoing issue, with researchers still trying to find a common terminology, as these age estimates remain important due to the legal aspects of suspected AHT. 60…”

“…The layering of blood and the appearance of blood on CT and during drainage can be used to estimate the frequency of rebleeding and the age of blood. This remains an ongoing issue, with researchers still trying to find a common terminology, as these age estimates remain important due to the legal aspects of suspected AHT …”