Head injury pattern in children can help differentiate accidental from non-accidental trauma
Related Experiment Video
Updated: Apr 23, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Jonathan P Roach1, Shannon N Acker, Denis D Bensard
1Department of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA.
Insights
Abusive head trauma (AHT) in children under 5 presents distinct radiographic findings compared to accidental head injury. Recognizing these patterns, such as subdural hemorrhages and diffuse axonal injury, is crucial for accurate diagnosis.
Area of Science:
- Pediatric Traumatology
- Radiology
- Forensic Medicine
Background:
- Differentiating abusive head trauma (AHT) from accidental head injury in young children is a critical diagnostic challenge.
- Radiographic findings play a pivotal role in identifying potential non-accidental trauma.
- Understanding these specific imaging patterns can aid clinicians in recognizing AHT.
Purpose of the Study:
- To identify and define radiographic findings that distinguish abusive head trauma (AHT) from accidental head injuries in children.
- To improve the diagnostic accuracy of AHT through the analysis of imaging characteristics.
Main Methods:
- Retrospective analysis of a trauma registry.
- Inclusion criteria: Children aged 5 years or younger with traumatic brain injury (TBI) between 1996 and 2011.
- Comparison of radiographic findings between AHT and accidental head injury groups.
Main Results:
- Abusive head trauma (AHT) accounted for 29% of traumatic brain injuries (TBIs) in the study cohort.
- Children with AHT exhibited higher injury severity scores and mortality rates compared to those with accidental injuries.
- Key differentiating findings included higher rates of subdural hemorrhage and diffuse axonal injury in AHT, while skull fractures and epidural hemorrhages were more common in accidental injuries.
Conclusions:
- Abusive head trauma (AHT) is associated with significantly higher mortality and specific radiographic findings, including subdural hemorrhages and diffuse axonal injury.
- A high index of suspicion for abuse is warranted in children presenting with subdural hematoma or diffuse axonal injury.
- Radiographic pattern recognition is essential for early and accurate diagnosis of AHT.
Objectives:
Our aim was to define the radiographic findings that help differentiate abusive head trauma (AHT) from accidental head injury.
Methods:
Our trauma registry was queried for all children ≤5 years of age presenting with traumatic brain injury (TBI) from 1996-2011.
Results:
Of 2,015 children with TBI, 71% had accidental injury and 29% had AHT. Children with AHT were more severely injured (ISS 22.1 vs 14.4; p < 0.0001) and had a higher mortality rate (15 vs 5%; p < 0.0001). Patients with AHT had higher rates of diffuse axonal injury (14 vs 8%; p < 0.0001) and subdural hemorrhage (76 vs 23%; p < 0.0001). Children with accidental injury had higher rates of skull fractures (52 vs 21%; p < 0.0001) and epidural hemorrhages (11 vs 3%).
Conclusions:
AHT occurred in 29% of children and resulted in increased mortality rates. These children had higher rates of subdural hemorrhages and diffuse axonal injury. Physicians initially evaluating injured children must maintain a high index of suspicion for abuse in those who present with subdural hematoma or diffuse axonal injury.
More Related Videos
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
09:49Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
