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Published on: January 20, 2023
Clinical analysis of non-accidental head injury in infants
1Department of Neurosurgery, School of Medicine, Sanglah General Hospital, Udayana University, Bali, Indonesia. golden105@hotmail.com
Insights
Infants with non-accidental head injury often present with subtle signs. Clinical and radiological findings, including intracranial hemorrhage, are key to diagnosis, even without visible trauma or retinal bleeding.
Area of Science:
- Pediatrics
- Neurology
- Forensic Medicine
Background:
- Non-accidental head injury (NAHI) is a significant cause of morbidity and mortality in infants.
- Diagnosis can be challenging due to the absence of overt physical signs of abuse.
Purpose of the Study:
- To describe the clinical features, radiological findings, and outcomes of infants with NAHI.
- To highlight the diagnostic importance of clinical and radiological evidence over the presence of external injuries or retinal bleeding.
Main Methods:
- Retrospective review of 39 infants presenting with suspected NAHI between 2001 and 2003.
- Analysis of clinical presentation, physical examination findings, CT scans, and patient outcomes.
- Classification of injury severity into mild, moderate, and severe.
Main Results:
- Presenting symptoms included seizures, vomiting, altered consciousness, and neurological deficits.
- CT scans revealed intracranial hemorrhage (subdural and subarachnoid) in all cases, often bilateral.
- Outcomes were generally poor, with 31% mortality and 23% good recovery; the rest had neurological impairments.
Conclusions:
- Clinical and radiological findings are crucial for diagnosing NAHI, even in the absence of retinal bleeding or obvious external trauma.
- The study emphasizes that the lack of specific external signs does not exclude non-accidental injury.
- Comprehensive assessment including detailed history, thorough examination, and imaging is vital for accurate diagnosis.
Abstract:
We present the clinical features, radiological findings and outcome of infants with non-accidental head injury presenting to our department between 2001 and 2003. There were 26 male and 13 female infants, aged between 7 days and 5 months. Presenting symptoms included seizures, vomiting, bulging fontanel, decreased level of consciousness, focal neurological signs, anemia and respiratory distress. We classified the patients into three groups: mild head injury (8 patients), moderate head injury (11 patients) and severe head injury (20 patients). Detailed history taking and thorough physical examination, did not reveal obvious injury or abuse (by the parents), other external visible injury or significant incidence of retinal bleeding. CT scan showed intracranial hemorrhage in all patients, most commonly including acute or acute on chronic subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) in the parafalcine and tentorial regions and over the brain convexity, associated with focal or diffuse hypodensity of the parenchyma. Intracranial lesions were mostly bilateral (80%). These patients generally had a poor outcome; 31% died, 23% had a good outcome, and the remainder recovered with neurological impairment of varying types and degrees. After comprehensive assessment, we concluded that all the cases in our series were "non-accidental" head injuries. However, the absence of retinal bleeding, visible external injury and recognised abuse in our series differed from reports by other investigators. In our opinion these features are not absolute requirements in diagnosing "non-accidental" injury and detailed history taking, thorough clinical examination and radiological studies were the key indicators of the diagnosis.
