Intracranial injuries after accidental head trauma in children under 3 years of age

Abstract

Summary Aim A retrospective study of common points found between the circumstances of occurrence and the presence of intracranial injuries in accidental head trauma for children under 3 years of age. Methodology All these children hospitalized at Angers University Hospital between 2002 and 2010 recovering from head trauma reported as accidental, having undergone a cerebral CT-scan were included. Conditions of occurrence were classified according to their mechanism. Cutaneous signs and fundus results were sought in medical files. Brain scans were reinterpreted according to a pre-determined grid. Results Thirty-four files were included. The occurrence mechanism was high energy in 20 cases, including six domestic accidents. Cutaneous signs were only observed in 17 files. The intracranial injuries identified comprised 16 parenchymal contusions of which eight with subdural hematomas, two isolated subdural hematomas, six epidural hematomas, and two subarachnoid hemorrhages. Subdural hematomas and complex bone fractures were always the result of high-energy mechanisms even when the accidents were domestic, while epidural hematomas could occur when accidents were low-energy. Conclusion Subdural hematomas are always the result of high-energy mechanisms, as are complex fractures. This concept is important when a variation exists between a traumatic mechanism reported as apparently benign and severe injuries. Effects on soft tissue are insufficiently described where they show evidence of a direct shock. These items highlight the importance of comparing the anamnestic record with clinical and radiological items, and to include expert appraisals from forensic examiners in order to prevent a failure to recognize a suspected abusive situation.