Initial Neurologic Presentation in Young Children Sustaining Inflicted and Unintentional Fatal Head Injuries

Abstract

BACKGROUND: It remains unclear if fatal brain injuries in young children are characterized by immediate rapid deterioration or can present after an initial period of lucidity. This issue has legal implications in child abuse, for which understanding the clinical course affects perpetrator identification. OBJECTIVE: To determine patterns of neurologic presentation on hospital admission in infants and toddlers who die of inflicted and unintentional injury. DESIGN/METHODS: Data on children 7, and 1.9% presented with a GCS score of >12 (lucid). The incidence of admission a GCS score of >7 varied by mechanism. Overall, children with inflicted injury were 3 times more likely to present with a GCS score of >7 than those injured in MVCs (odds ratio [OR]: 3.6; 95% confidence interval [CI]: 1.2-10.3), but incidence of a GCS score of >7 did not differ between inflicted injuries and falls. Similarly, when considering only those children >or=24 months old, a GCS score of >7 did not differ by mechanism. In contrast, in those 10 times more likely to have a GCS score of >7 than those who died as a result of a MVC (OR: 9.36; 95% CI: 1.3-80.9). CONCLUSIONS: The data suggest an age- and mechanism-dependent presentation of neurologic status in children with fatal head injury. Although infrequent, young victims of fatal head trauma may present as lucid (GCS score: >12) before death. Furthermore, children 7) than those in MVCs. This effect is amplified in the youngest children (12 [5 of 6]). It is unclear whether these differences are the result of inadequate tests to evaluate consciousness in younger children or differences in biomechanical mechanisms of inflicted trauma. Language: en