Spinal subdural hemorrhage in abusive head trauma: a retrospective study

Area of Science:

• Pediatric Traumatology
• Neuroradiology
• Forensic Medicine

Background:

• Spinal subdural hemorrhage (SSH) is a critical indicator in pediatric trauma.
• Distinguishing between abusive head trauma (AHT) and accidental head trauma (AHT) is crucial for patient care and legal proceedings.
• The incidence and characteristics of SSH in AHT versus accidental trauma require further clarification.

Purpose of the Study:

• To compare the incidence, distribution, and radiologic features of spinal subdural hemorrhage in children with abusive head trauma versus accidental trauma.
• To determine the diagnostic utility of spinal imaging in differentiating AHT from accidental injuries.
• To establish the prevalence of SSH in pediatric head trauma cases.

Main Methods:

• Retrospective review of 252 children (0-2 years) with AHT and 70 children with accidental trauma.
• Analysis of clinical data and cross-sectional imaging (CT, MRI) of the brain, spine, chest, abdomen, and pelvis.
• Statistical comparison using Fisher exact test to assess the significance of SSH incidence between groups.

Main Results:

• Spinal imaging was evaluable in 67 of 252 AHT cases; 63% of those with thoracolumbar imaging had SSH.
• Only 1% of children with accidental injury had SSH, associated with an occipital fracture.
• The difference in SSH incidence between AHT and accidental trauma was statistically significant (P < .001).

Conclusions:

• Spinal canal subdural hemorrhage is highly prevalent in children with abusive head trauma who undergo thoracolumbar imaging.
• SSH is a rare finding in children with accidental head trauma.
• These findings underscore the importance of spinal imaging in the evaluation of pediatric head injuries, particularly in suspected AHT.