Pediatric Traumatic Brain Injury and Associated Topics: An Overview of Abusive Head Trauma, Nonaccidental Trauma, and Sports Concussions

Abstract

Pediatric traumatic brain injury (TBI) uniquely affects the pediatric population. Abusive head trauma (AHT) is a subset of severe pediatric TBI usually affecting children in the first year of life. AHT is a form of nonaccidental trauma. Sports-related TBI resulting in concussion is a milder form of TBI affecting older children. Current recommended perioperative management of AHT and sports concussions relies on general pediatric TBI guidelines. Research into more specific pediatric TBI screening and management goals is ongoing. This article reviews the epidemiology, mechanisms, clinical signs, and management of AHT and sports-related concussions.

Keywords: Brain injuries; Child abuse; Concussion; Mild traumatic brain injury; Preoperative evaluation; SCAT-3; Sports-related head injury.

Fig. 1.

Abusive head trauma. Axial T1-weighted (A) and T2-weighted (B) MRI scans of an infant reveal bilateral subdural blood collections of different ages. Right collection shows blood in the late subacute phase (2–4 weeks old), and left shows blood in the chronic phase (>1 month). This finding is highly suggestive of repeated abuse. (From Michelson DJ, Ashwal S. Neuroimaging. In: Vincent JL, Abraham E, Moore FA, et al, editors. Textbook of critical care. 6th edition. Philadelphia: Saunders; 2011; with permission.)

Fig. 2.

Watershed pattern of supratentorial hypoxic ischemic injury. Four-month-old boy with acute mental status change and seizures. (A) Computed tomography on admission to the emergency room shows bilateral chronic subdural collections with evidence of acute bleed on the left (arrow). Loss of gray-white matter discrimination because of cortical edema is present bilaterally. (B) MRI axial diffusion, B1000, shows bilateral watershed areas of restricted diffusion in watershed distribution. (C) MRI coronal diffusion, B1000, shows bilateral watershed areas of restricted diffusion. (From Zimmerman RA, Bilaniuk LT, Farina L. Non-accidental brain trauma in infants: diffusion imaging, contributions to understanding the injury process. J Neuroradiol 2007;34(2):111; with permission.)

Fig. 3.

(A) RetCam photographs of a 3-month-old boy diagnosed with AHT who subsequently died. The posterior pole and periphery showed no hemorrhages, but there were severe multilayered hemorrhages noted in the left eye, with preretinal hemorrhage layered in the inferior macula of the left eye. (B) RetCam photographs of a 4-month-old boy diagnosed with AHT showing bilateral severe retinal hemorrhages greater in the left eye. The hemorrhages are asymmetric, with the left side having more hemorrhages than the right, but both show multilayered retinal hemorrhages in the posterior pole and periphery. (From Longmuir SQ, McConnell L, Oral R, et al. Retinal hemorrhages in intubated pediatric intensive care patients. J AAPOS 2014;18(2):132; with permission.)