Occult Cranial Injuries Found with Neuroimaging in Clinically Asymptomatic Young Children Due to Abusive Compared to Accidental Head Trauma

Abstract

To compare occult brain injuries on neuroimaging in clinically asymptomatic children under 20 months due to abusive versus accidental head trauma. A retrospective review of 58 children under 20 months who underwent neuroimaging for possible abusive trauma was performed. The data collected were demographics, neurological signs/symptoms, imaging findings, and disposition (abusive or accidental). The disposition of 31 subjects was abusive trauma and 27 were accidental. At presentation, 8/31(25.8%) children with abusive injury and 15/27(55.6%) with accidental injury were neurologically asymptomatic. Neuroimaging was abnormal in 6 of 8 (75.0%) asymptomatic children with abusive injury, and 13/15 (86.7%) children with accidental trauma. No significant (P = 0.59) difference in frequency of abnormal neuroimaging was seen between the asymptomatic abusive and accidental trauma groups. Although victims of abusive trauma under 20 months of age are less often neurologically asymptomatic compared to accidental trauma victims, neuroimaging revealed a high rate of occult traumatic brain injury in both groups.