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Spinal subdural hemorrhage in abusive head trauma: a retrospective study
Arabinda Kumar Choudhary1, Ray K Bradford, Mark S Dias
1Department of Radiology, Penn State University College of Medicine, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA. achoudhary@hmc.psu.edu
Insights
Spinal subdural hemorrhage is significantly more common in children with abusive head trauma than in those with accidental injuries. This finding highlights the importance of spinal imaging in suspected abusive head trauma cases.
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.
Purpose:
To compare the relative incidence, distribution, and radiologic characteristics of spinal subdural hemorrhage after abusive head trauma versus that after accidental trauma in children.
Materials And Methods:
This study received prior approval from the Human Subjects Protection Office. Informed consent was waived. This study was HIPAA compliant. Two hundred fifty-two children aged 0-2 years treated for abusive head trauma at our institute between 1997 and 2009 were identified through retrospective chart review. A second group of 70 children aged 0-2 years treated at our institute for well-documented accidental trauma between 2003 and 2010 were also identified through retrospective chart review. All clinical data and cross-sectional imaging results, including computed tomographic and magnetic resonance imaging of the brain, spine, chest, abdomen, and pelvis, were reviewed for both of these groups. A Fisher exact test was performed to assess the statistical significance of the proportion of the spinal canal subdural hemorrhage in abusive head trauma versus that in accidental trauma.
Results:
In the abusive head trauma cohort, 67 (26.5%) of 252 children had evaluable spinal imaging results. Of these, 38 (56%) of 67 children had undergone thoracolumbar imaging, and 24 (63%) of 38 had thoracolumbar subdural hemorrhage. Spinal imaging was performed in this cohort 0.3-141 hours after injury (mean, 23 hours ± 27 [standard deviation]), with 65 (97%) of 67 cases having undergone imaging within 52 hours of injury. In the second cohort with accidental injury, only one (1%) of 70 children had spinal subdural hemorrhage at presentation; this patient had displaced occipital fracture. The comparison of incidences of spinal subdural hemorrhage in abusive head trauma versus those in accidental trauma was statistically significant (P < .001).
Conclusion:
Spinal canal subdural hemorrhage was present in more than 60% of children with abusive head trauma who underwent thoracolumbar imaging in this series but was rare in those with accidental trauma.
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