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Intracranial injuries on computed tomography head scans in infants investigated for suspected physical abuse: a
Helen Daley1, Hilary Smith2, Samantha McEvedy3
1Department of Community Paediatrics, Solent NHS Trust, Fareham, UK helen.daley@nhs.net.
Insights
CT head scans for suspected infant abuse are most valuable when infants show neurological signs, skull fractures, or scalp injuries. Routine scans for all infants may not be beneficial due to radiation risks.
Area of Science:
- Pediatric radiology
- Child abuse investigation
- Medical imaging safety
Background:
- UK guidelines mandate CT head scans for infants under 12 months with suspected physical abuse.
- CT scans carry radiation risks, necessitating careful consideration of their use.
- Previous studies show variable yields for detecting intracranial injuries in suspected abuse cases.
Purpose of the Study:
- Determine the diagnostic yield of CT head scans for intracranial injuries in infants investigated for suspected physical abuse.
- Compare the yield of CT scans in infants with and without signs of head injury.
- Identify clinical and radiological features associated with intracranial injuries.
Main Methods:
- Retrospective cross-sectional review of infant case records undergoing skeletal surveys for suspected physical abuse.
- Analysis of CT head scan results to identify intracranial injuries.
- Comparison of injury yield based on presenting clinical signs.
Main Results:
- Overall yield of intracranial injury was 10% (37 of 363 scans).
- Infants with neurological signs or skull fractures had a 53% (36 of 68) yield of intracranial injury.
- Infants without these signs had a very low yield (0.34%, 1 of 295), with the injury attributed to an accidental fall. Scalp injury was associated with intracranial injury.
Conclusions:
- CT head scans are highly valuable in infants with suspected physical abuse presenting with neurological signs, skull fractures, or scalp injuries.
- The routine use of CT head scans for all infants investigated for suspected abuse warrants re-evaluation due to potential risks versus benefits.
- Targeted imaging based on clinical presentation may optimize diagnostic yield and minimize radiation exposure.
Background:
UK national guidelines recommend that investigation of infants (aged <12 months) with suspected physical abuse should always include CT head scans. Such imaging carries small but recognised risks from radiation exposure. Studies report a range of yields for occult intracranial injuries in suspected physical abuse.
Aims:
To report the yield of intracranial injuries on CT head scans carried out for suspected physical abuse in infants, compare yields for those presenting with or without signs of head injury and to describe selected clinical and radiological features.
Methods:
A retrospective cross-sectional review of case records of infants undergoing skeletal survey for suspected physical abuse in Wessex, England. The main outcome measure was yield of intracranial injuries on CT head scan.
Results:
In total, n=363 CT head scans were included (n=275 aged <6 months). The overall yield of intracranial injury was 37 (10%). Among 68 infants presenting with neurological signs or skull fractures, yield was 36 (53%) compared with just 1 (0.34%) of 295 without neurological signs or skull fractures. This one intracranial injury was found to be consistent with an accidental fall. Scalp injury was the only additional clinical feature associated with intracranial injury.
Conclusion:
In suspected physical abuse, CT head scans should be carried out in infants who present with neurological signs, skull fractures or scalp injuries. However, in balancing potential risks and benefits, we question the value of performing a CT head scan in every infant investigated for suspected physical abuse.
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