More data, more questions: No simple answer about which children should undergo screening neuroimaging for clinically
M Katherine Henry1, Daniel M Lindberg2, Joanne N Wood3
1Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
Insights
Abusive head trauma (AHT) is a leading cause of fatal child abuse. Early detection is challenging due to subtle symptoms, but identifying high-risk children can improve diagnosis and prevent further injury.
Area of Science:
- Pediatrics
- Child Abuse Research
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is the primary cause of fatal child physical abuse.
- Clinically occult AHT presents diagnostic challenges due to subtle or absent overt symptoms.
- Missed early detection of AHT in medical settings can lead to recurrent injuries.
Purpose of the Study:
- To review the literature on neuroimaging yield for detecting clinically occult AHT.
- To identify risk factors associated with occult AHT in children undergoing abuse evaluations.
- To explore reasons for variability in research findings and suggest future research directions.
Main Methods:
- Literature review of studies on neuroimaging in AHT detection.
- Analysis of risk factors for clinically occult AHT.
- Discussion of inter-study variations and research gaps.
Main Results:
- Neuroimaging is crucial for diagnosing clinically occult AHT but carries risks.
- Existing research on neuroimaging yield and risk factors for AHT shows wide variation.
- Identifying high-risk children is essential for developing effective imaging decision support tools.
Conclusions:
- Accurate identification of children at highest risk for occult AHT is critical.
- Further research is needed to refine evidence-based imaging guidelines for suspected AHT.
- Improved diagnostic strategies can enhance early detection and mitigate harm from abusive head trauma.
Abstract:
Abusive head trauma (AHT) is the leading cause of fatal child physical abuse. Victims may initially present with clinically occult AHT without overt signs of head trauma or with only subtle, nonspecific symptoms, which can make timely recognition of AHT challenging. Research has shown missed opportunities for early detection of AHT in the medical setting are common and can lead to repeated injury. Neuroimaging is needed to diagnose clinically occult AHT but is not without risk. Researchers have worked to understand the yield of neuroimaging in detection of clinically occult AHT and to identify risk factors, yet findings have varied widely across studies. Identifying which children undergoing physical abuse evaluations are at highest risk of clinically occult AHT is key to development of evidence-based imaging decision support tools for clinicians. Here we discuss the recent literature, identify potential reasons for variation across studies, and offer opportunities for future research.
