Head Injury in Abused Children (Review of 190 Cases Over 30 Years)

Abstract

Despite three decades of awareness, the incidence of child abuse is still rising. Among various types of maltreatment, head injury remains one of the most serious and disabling of injuries. Because its symptoms and signs often mimic those of other childhood illnesses and because the history of the illness given is often misleading or minimized, the diagnosis can be delayed or missed. The objective of this study was to identify the key symptoms and signs, their risk factors and their frequency, to evaluate the value of diagnostic methods, clues, and trends of the past three decades, and to identify the serious outcomes associated with head injury as compared with those of maltreatment elsewhere in the body. The records of 190 abused children whose primary trauma was head injury serious enough to require hospitalization were retrospectively reviewed. We collected data on signs and symptoms, diagnostic studies, trends, and outcomes. The risk factor for each symptom and sign was identified. Unlike victims of other maltreatments, more than 80% of these children were younger than 2 years. Key symptoms were depressed levels of consciousness (64%), respiratory distress (32%), seizures (32%), and vomiting (23%). Key signs were retinal hemorrhage (41%), bulging fontanel (44%), and pupillary changes (22.5%). Fever is not uncommon. Each sign and symptom is associated with a certain risk factor. Mortality and morbidity (37%) for these children far surpass those for other abused children injured elsewhere in the body.