Related Experiment Video
Updated: Sep 21, 2025
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Comparison of abusive head trauma versus non-inflicted subdural haematoma in infants: A retrospective cohort study
Peter J Snelling1,2,3,4, Anthony Aruljoe Thanasingam1, Philip Jones1,3,5
1Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Insights
Abusive head trauma (AHT) in infants under two years old is linked to severe outcomes like death and disability. Early identification in the emergency department is crucial for intervention and specialized care.
Area of Science:
- Pediatric medicine
- Neurology
- Forensic pathology
Background:
- Subdural hematoma (SDH) in young children can result from either inflicted or non-inflicted causes.
- Distinguishing between abusive head trauma (AHT) and accidental injuries is critical for child protection and patient outcomes.
Purpose of the Study:
- To compare the clinical, radiological, and outcome characteristics of subdural hematoma (SDH) in children under two years old.
- To differentiate between SDH caused by abusive head trauma (AHT) and non-inflicted etiologies.
Main Methods:
- Retrospective cohort study of 37 infants with SDH presenting to a tertiary children's hospital.
- Aetiology classified into AHT and non-inflicted groups based on child protection assessments.
- Comparison of clinical, radiological, and outcome data between the two groups.
Main Results:
- Of 37 SDH cases, 20 were attributed to AHT and 17 to non-inflicted causes.
- AHT-related SDH associated with maternal drug use, child safety involvement, delayed presentation, seizures, altered consciousness, fractures, bruising, retinal hemorrhages, deeper/bilateral/posterior fossa bleeds, and worse outcomes.
- Non-inflicted SDH associated with witnessed injury, falls, and scalp hematomas.
Conclusions:
- Infant SDH due to AHT carries a high risk of mortality and long-term disability.
- Early identification of potential AHT in the emergency department is essential.
- Referral to specialized child abuse investigation units is crucial for timely intervention.
Objectives:
To compare the characteristics of subdural haematoma (SDH) in children under the age of 2 years, between inflicted, otherwise known as abusive head trauma (AHT), and non-inflicted aetiologies.
Methods:
This was a retrospective cohort study of 37 cases of SDH in children under the age of 2 years presenting to the ED at an Australian tertiary children's hospital between January 2009 and December 2012 and been assessed by the Child Protection Unit. SDH aetiology was classified into AHT and non-inflicted groups, based on child protection interagency outcome. These groups were compared to determine clinical associations with AHT.
Results:
Of the 37 infants with SDH, 20 cases were deemed due to AHT, whereas 17 cases were determined to be non-inflicted SDH (15 cases due to accidental trauma and two cases due to congenital benign enlargement of the subarachnoid space). SDH due to AHT was associated with antenatal maternal drug use, previous Department of Child Safety involvement, delayed presentation, history of seizures, floppiness or altered level of consciousness; extracranial findings of fractures, bruising or retinal haemorrhages; radiological findings of >5 mm depth, bilateral, inter-hemispheric blood, posterior fossa blood and diffusion restriction; and outcomes of death or permanent disability. Non-inflicted SDH was associated with witnessed injury, falls and scalp haematoma on imaging.
Conclusions:
Infant SDH due to AHT accounts for high mortality and morbidity. Early identification of these patients in the ED with referral to specialised units that investigate for potential child abuse is essential.
