Intracranial Injuries in Asymptomatic Infants Undergoing Subspecialty Evaluation for Physical Abuse: A Multicenter...

Area of Science:

• Pediatric medicine
• Neurology
• Child abuse research

Background:

• The prevalence of intracranial injuries (ICI) in infants suspected of abuse but without symptoms is not well-established.
• Variability in defining "asymptomatic" complicates neuroimaging decisions for these infants.

Purpose of the Study:

• To determine ICI prevalence in infants evaluated for abuse but lacking seizures or altered mental status (AMS).
• To analyze how different definitions of "asymptomatic" affect ICI prevalence across age groups.
• To investigate the influence of hospital-level neuroimaging rates on identified ICI prevalence.

Main Methods:

• A cross-sectional study of infants under 12 months evaluated for physical abuse was conducted.
• Infants without seizures or AMS were analyzed, with progressively stricter definitions of "asymptomatic" applied.
• Data were collected from February 2021 to December 2022 within the Child Abuse Pediatric Network (CAPNET).

Main Results:

• Of 1947 infants without seizures or AMS, 1513 (77.7%) underwent neuroimaging.
• Overall ICI prevalence was 13.7% in this cohort.
• When strictly defined as asymptomatic (excluding blunt head injury, neurological signs, and non-specific symptoms), ICI prevalence decreased to 4.7% (approximately 1 in 21).

Conclusions:

• The definition of "asymptomatic" significantly impacts the reported prevalence of ICI in infants evaluated for abuse.
• Strictly defined asymptomatic ICI occurs in approximately 5% of infants undergoing abuse evaluations.
• Infants under 6 months without signs of blunt head trauma exhibit a higher risk of ICI compared to older infants.