Occult head trauma in young suspected victims of physical abuse

To determine the frequency of neuroimaging and ophthalmology consults in children evaluated for physical abuse without neurologic symptoms and the diagnostic yield of these studies.

Records of neurologically asymptomatic patients younger than 48 months evaluated with a skeletal survey at two academic medical centers were reviewed for frequency of CT or MRI and ophthalmology consults, the results of these tests, and factors associated with given evaluations. Factors associated with positive findings during evaluation were also analyzed.

Fifty-one patients had a skeletal survey and no clinical signs of intracranial injury. Seventy-five percent of patients had CT or MRI; 69% had formal evaluation for retinal hemorrhages. Twenty-nine percent had evidence of intracranial injury without neurologic symptoms. Age less than 12 months was the only factor significantly associated with neuroimaging (90% vs 55%, P=.004). Sex, race, insurance, and having an unrelated male caretaker were not significantly associated with performance of neuroimaging or findings of intracranial injury.

Age less than 1 year was the only significant factor associated with the diagnostic evaluation. Neither retinal hemorrhage nor historic factors were sensitive markers for abnormalities found by neuroimaging. Clinicians should have a low threshold for neuroimaging when physical abuse is suspected in a young child.