Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr 29;5(3):265-271.
doi: 10.1002/ams2.341. eCollection 2018 Jul.

Characteristics distinguishing abusive head trauma from accidental head trauma in infants with traumatic intracranial hemorrhage in Japan

Shunsuke Amagasa  1 , Hikoro Matsui  1 , Satoshi Tsuji  2 , Satoko Uematsu  2 , Takashi Moriya  3 , Kosaku Kinoshita  4
Affiliations

Characteristics distinguishing abusive head trauma from accidental head trauma in infants with traumatic intracranial hemorrhage in Japan

Shunsuke Amagasa et al. Acute Med Surg. .

Abstract

Aim: To identify markers for detecting abusive head trauma (AHT) and its characteristics in the Japanese population.

Methods: We retrospectively reviewed the clinical records of 166 infants with traumatic intracranial hemorrhage between 2002 and 2013 in three tertiary institutions in Japan. The infants were classified into AHT (57), suspected AHT (24), and accidental (85) group based on the defined criteria. We compared clinical presentations and computed tomography findings among these three groups and also compared age distribution of infants with AHT in our study to those in the USA.

Results: Age distribution of AHT cases is significantly higher in our study than in the USA (P < 0.001). The rates of male sex, bruising, retinal hemorrhage, subdural hematoma, cerebral edema, and neurological sequelae were significantly higher, and those of skull fracture and scalp finding were significantly lower, in the AHT group than in the accidental group (P < 0.05). In the multivariable analysis of the infants with subdural hematoma, absence of skull fracture (odds ratio = 42.1; 95% confidence interval, 3.5-507.7, P = 0.003) was associated with AHT.

Conclusions: The age range of AHT in Japan is significantly different from that of countries in Europe and North America because of familial and sociocultural situations. Absence of bruising, and rib or long bone fractures did not reduce the likelihood of AHT. Subdural hematoma without findings of an impact to the head strongly suggested AHT. Abusive head trauma is a global problem, however, diagnosis and defensive measures likely need to be tailored to accommodate cultural risk factors.

Keywords: Abusive head trauma; diagnosis; infant; physical abuse; subdural hematoma.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart of this population of Japanese infants with traumatic intracranial hemorrhage with abusive head trauma (AHT), suspected AHT, or accidental injury.
Figure 2
Figure 2
Age distribution of Japanese infants with traumatic intracranial hemorrhage classified to the abusive head trauma (AHT), suspected AHT, and accidental injury groups. Two peaks in the number of patients were observed in the AHT group, one at approximately 1–2 months and the other at 6–8 months.
Figure 3
Figure 3
Comparison of age distribution of abusive head trauma (AHT) cases between our study and a study carried out in the USA. Age distribution of AHT cases is significantly higher in our study than in the US study (P < 0.001).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Piteau SJ, Ward MG, Barrowman NJ et al Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics 2012; 130: 315–23. - PubMed
    1. Kemp AM, Jaspan T, Griffirhs J et al Neuroimaging: what neuroradiological features distinguish abusive from non‐abusive head trauma? A systematic review Arch. Dis. Child. 2011; 96: 1103–12. - PubMed
    1. Hymel KP, Armijo‐Garcia V, Foster R et al Validation of a clinical prediction rule for pediatric abusive head trauma. Pediatrics 2014; 134: 1537–44. - PubMed
    1. Cowley LE, Morris CB, Maguire SA et al Validation of a prediction tool for abusive head trauma. Pediatrics 2015; 136: 290–8. - PubMed
    1. Mizoguchi T, Takizawa T, Mori R et al Report on child death registration in 2011 in the pilot four region (in Japanese). J. Jpn. Pediatr. Soc. 2016; 120: 662–72.

LinkOut - more resources