An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging
G Orman1, S F Kralik2, N K Desai2
1From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., T.A.G.M.H.) gxorman@texaschildrens.org.
Insights
Neuroimaging findings like hypoxic-ischemic injury and spinal ligamentous injury are associated with poor outcomes in abusive head trauma cases. These findings can help predict prognosis in affected children.
Area of Science:
- Pediatric Radiology
- Child Abuse Forensics
- Neurology
Background:
- Abusive head trauma (AHT) is a leading cause of severe injury and death in young children.
- Radiological imaging is crucial for diagnosing AHT, but no single finding is definitively diagnostic.
- Identifying prognostic indicators from neuroimaging is essential for patient management.
Purpose of the Study:
- To determine the prevalence of brain and spine neuroimaging findings in children with AHT.
- To analyze the association between specific neuroimaging findings and clinical factors.
- To identify neuroimaging findings that may serve as prognostic indicators for AHT outcomes.
Main Methods:
- Retrospective study of 102 children diagnosed with AHT between January 2018 and February 2021.
- Analysis of patient demographics, survival, Glasgow Coma Scale (GCS) scores, and hospital/ICU lengths of stay.
- Categorization of brain findings (classic/nonclassic) and assessment of spine MRIs for ligamentous injury, fractures, and hemorrhage.
Main Results:
- Subdural hematoma was the most common classic finding (83.3%); bridging vein thrombosis was the most common nonclassic finding (30.4%).
- Spinal ligamentous injury was present in 23/49 patients.
- Hypoxic-ischemic injury correlated with mortality (P=.0001) and lower GCS scores (P<.0001). Intraventricular hemorrhage, diffuse axonal injury, hypoxic-ischemic injury, arterial stroke, and spinal ligamentous injury were associated with longer hospital and/or ICU stays.
Conclusions:
- Specific neuroimaging findings, including hypoxic-ischemic injury and spinal ligamentous injury, are significantly associated with adverse outcomes in AHT.
- The presence of intraventricular hemorrhage, diffuse axonal injury, hypoxic-ischemic injury, arterial stroke, and/or spinal ligamentous injury may indicate a poor prognosis in pediatric AHT.
- These findings aid in the prognostic assessment of children with abusive head trauma.
Background And Purpose:
Abusive head trauma is the leading cause of morbidity and mortality in young children. Radiology provides valuable information for this challenging diagnosis, but no single neuroimaging finding is independently diagnostic of abusive head trauma. Our purposes were to describe the prevalence of brain and spine neuroimaging findings and to analyze the association of neuroimaging findings with clinical factors to determine which neuroimaging findings may be used as prognostic indicators.
Materials And Methods:
Children with a confirmed abusive head trauma diagnosis between January 2018 to February 2021 were included in this single-center retrospective study. Patient demographics, survival, Glasgow Coma Scale score on admission, length of hospital stay, and intensive care unit stay were examined. Brain neuroimaging findings were categorized as classic and nonclassic findings. Spine MRIs were also assessed for spinal ligamentous injury, compression fracture, and hemorrhage. The χ2 test or the Wilcoxon rank-sum test was used for the analysis.
Results:
One hundred two children (male/female ratio: 75:27; average age, 9.49; range, 0.27-53.8 months) were included. Subdural hematoma was the most common (83.3%) classic neuroimaging finding. Bridging vein thrombosis was the most common (30.4%) nonclassic neuroimaging finding. Spinal ligamentous injury was seen in 23/49 patients. Hypoxic-ischemic injury was significantly higher in deceased children (P = .0001). The Glasgow Coma Scale score was lower if hypoxic-ischemic injury (P < .0001) or spinal ligamentous injury were present (P = .017). The length of hospital stay was longer if intraventricular hemorrhage (P = .04), diffuse axonal injury (P = .017), hypoxic-ischemic injury (P = .001), or arterial stroke (P = .0003) was present. The intensive care unit stay was longer if intraventricular hemorrhage (P = .02), diffuse axonal injury (P = .01), hypoxic-ischemic injury (P < .0001), or spinal ligamentous injury (P = .03) was present.
Conclusions:
Our results may suggest that a combination of intraventricular hemorrhage, diffuse axonal injury, hypoxic-ischemic injury, arterial stroke, and/or spinal ligamentous injury on neuroimaging at presentation may be used as potential poor prognostic indicators in children with abusive head trauma.
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