Efficacy of Child Abuse Evaluations for Infants With Possible Subdural Hemorrhage Identified on Cranial Ultrasound...

Area of Science:

• Pediatric neurology
• Child abuse pediatrics
• Medical imaging

Background:

• Abusive head trauma (AHT) is a leading cause of infant morbidity and mortality.
• Evaluating infants for AHT can be challenging, particularly with nonspecific findings or well-appearing children.
• Subdural collections on cranial ultrasound for macrocephaly warrant careful consideration for potential abuse.

Purpose of the Study:

• To describe the presentation, evaluation, and diagnoses of infants with abnormal subdural collections identified via cranial ultrasound for macrocephaly.
• To determine the frequency of abusive head trauma (AHT) diagnosis in this specific infant population.
• To highlight inconsistencies in child abuse workups for infants presenting with asymptomatic macrocephaly and possible subdural hemorrhage.

Main Methods:

• Retrospective case series.
• Review of 7 infant cases presenting with asymptomatic macrocephaly and abnormal subdural collections on cranial ultrasound.
• Analysis of the extent of physical abuse evaluations performed.

Main Results:

• All 7 patients presented with asymptomatic macrocephaly.
• The scope of diagnostic workups for potential abuse varied significantly among the cases.
• No infants were diagnosed with suspicious injuries indicative of abuse during the initial evaluation or in the subsequent year.

Conclusions:

• Significant variability exists in child abuse workups for infants with asymptomatic macrocephaly and possible subdural hemorrhage.
• There is a critical need for standardized clinical guidelines for pediatric evaluations in this patient group.
• Developing a consistent approach is essential for accurate diagnosis and management of potential abusive head trauma.