Subdural hematomas in children under 2 years: insights from a tertiary hospital in Saudi Arabia

Area of Science:

• Pediatrics
• Neurology
• Forensic Medicine

Background:

• Head trauma is a significant cause of morbidity and mortality in infants and young children.
• Subdural hematoma (SDH) is a life-threatening complication of head trauma, particularly in children under two years of age.
• Differentiating between inflicted (abusive) and non-inflicted (accidental) causes of SDH is crucial for appropriate medical and legal management.

Purpose of the Study:

• To analyze and compare the characteristics and outcomes of inflicted versus non-inflicted subdural hematoma in children under two years of age.
• To identify potential differentiating factors between abusive head trauma and accidental head injuries leading to SDH in this age group.

Main Methods:

• A retrospective study was conducted at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia, from 2014 to 2019.
• Data were collected for 63 patients under two years of age diagnosed with SDH.
• Information was gathered from electronic hospital records and Suspected Child Abuse and Neglect (SCAN) team documentation.

Main Results:

• Out of 63 patients, 17 (27%) had inflicted SDH, while 46 (73%) had non-inflicted causes (falls, medical reasons, motor vehicle accidents).
• Inflicted SDH cases were predominantly male (p = 0.018).
• Children with inflicted SDH exhibited more severe symptoms and worse outcomes compared to those with non-inflicted SDH.

Conclusions:

• Abusive head trauma is a significant cause of subdural hematoma in children under two years old.
• Inflicted SDH is associated with more severe clinical presentations and poorer prognoses.
• Clinical vigilance and thorough investigation are essential when evaluating SDH in young children to distinguish between abuse and accidental injury.