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Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma
Meghann M Ronning1, Patrick L Carolan2, Gretchen J Cutler3
1Department of Emergency Medicine, Children's Hospital and Clinics of Minnesota, 2525 Chicago Ave., Minneapolis, MN, 55404, USA. meghann.ronning@childrensmn.org.
Insights
Parasagittal vertex clots on CT scans are strongly associated with abusive head trauma (AHT) in infants. This finding in infants with subdural hemorrhage (SDH) warrants suspicion for abuse, especially when the injury mechanism is unclear.
Area of Science:
- Pediatric Radiology
- Forensic Pathology
- Child Abuse Pediatrics
Background:
- Abusive head trauma (AHT) is a leading cause of subdural hemorrhage (SDH) in infants.
- Parasagittal vertex clots on imaging are suspected indicators of AHT, but require further study.
- Limited research exists on parasagittal vertex clots, especially in controlled studies.
Purpose of the Study:
- To compare parasagittal vertex clots on CT scans in infants with SDH due to AHT versus accidental trauma.
- To investigate the presence of parasagittal vertex clots in infants with accidental head trauma but without SDH.
Main Methods:
- Retrospective review of CT scans from infants under 12 months with SDH (2004-2014).
- Independent, blinded review by a pediatric neuroradiologist to identify parasagittal vertex clots.
- Comparison with age-matched controls with accidental head injury but no SDH.
Main Results:
- Of 99 infants with SDH, 55.6% had AHT and 22.2% had accidental trauma.
- Parasagittal vertex clots were present in 81.2% of AHT cases versus 36.4% of accidental trauma cases.
- Patients with parasagittal vertex clots had 8 times the odds of AHT and were more likely to have retinal hemorrhage or hypoxic-ischemic changes.
Conclusions:
- The presence of parasagittal vertex clots on infant CT scans should increase suspicion for AHT.
- This finding necessitates further investigation, particularly when the reported mechanism of injury is unknown, uncertain, or inconsistent.
Background:
Abusive head trauma (AHT) is the most common cause of subdural hemorrhage (SDH) in infants younger than 12 months old. Clot formation in the parasagittal vertex seen on imaging has been associated with SDH due to AHT. There have been very few studies regarding these findings; to our knowledge, no studies including controls have been performed.
Objective:
To describe parasagittal vertex clots on head computed tomography (CT) in infants with SDH and AHT compared to patients with SDH and accidental trauma, and to evaluate for parasagittal vertex clots in the absence of SDH in the setting of known accidental head trauma.
Materials And Methods:
All infants younger than 12 months old with SDH present on CT scan were retrospectively identified from 2004 to 2014. Blinded, independent review of all CT scans for clot formation at the parasagittal vertex was performed by a pediatric neuroradiologist.
Results:
Ninety-nine patients were eligible for analysis. Mean age was 4 months. Fifty-seven (57.6%) were male. Fifty-five (55.6%) patients were identified as having AHT and 22 (22.2%) had accidental trauma. Forty-five (81.2%) patients with AHT had parasagittal vertex clots present on CT scan compared to 8 (36.4%) patients with accidental trauma. Compared to patients without parasagittal vertex clots, those with parasagittal vertex clots were more likely to have AHT (66.2% vs. 32.3%, P=0.001), no known mechanism of injury (69.1% vs. 32.3%, P=0.015), retinal hemorrhage (75% vs. 35.5%, P=0.002) and hypoxic-ischemic changes (25% vs. 0%, P=0.002). Patients with parasagittal vertex clots have eight times the odds of AHT compared to patients without parasagittal vertex clots. Age-matched control patients who underwent head CT scan due to a history of accidental head injury without SDH were identified (n=87); no patient in the control group had parasagittal vertex clots.
Conclusion:
The finding of parasagittal vertex clots on CT scans should raise suspicion for abuse and prompt further investigation, especially in the setting of no known, uncertain or inconsistent mechanism of injury.
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