Occult cranial injuries found with neuroimaging in clinically asymptomatic young children due to abusive compared to accidental head trauma

Abstract

Objective: To compare occult brain injuries on neuroimaging in clinically asymptomatic children under 20 months due to abusive versus accidental head trauma.

Subjects and methods: A retrospective review of 58 children under 20 months who underwent neuroimaging for possible abusive trauma was performed. The data collected were demographics, neurological signs/symptoms, imaging findings, and disposition (abusive or accidental).

Results: The disposition of 31 subjects was abusive trauma and 27 were accidental. At presentation, 8/31(25.8%) children with abusive injury and 15/27(55.6%) with accidental injury were neurologically asymptomatic. Neuroimaging was abnormal in 6 of 8 (75.0%) asymptomatic children with abusive injury, and 13/15 (86.7%) children with accidental trauma. No significant (P = 0.59) difference in frequency of abnormal neuroimaging was seen between the asymptomatic abusive and accidental trauma groups.

Conclusions: Although victims of abusive trauma under 20 months of age are less often neurologically asymptomatic compared to accidental trauma victims, neuroimaging revealed a high rate of occult traumatic brain injury in both groups.