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Non-accidental head injury in children
1Prince of Wales Children's Hospital, Randwick, NSW.
Insights
Non-accidental head injuries in children often present with histories inconsistent with clinical findings. Retinal hemorrhages and unconsciousness are key indicators of poor outcomes in pediatric head trauma.
Area of Science:
- Pediatric Traumatology
- Child Abuse Pediatrics
- Neurology
Background:
- Non-accidental head injury (NAHI) is a significant cause of morbidity and mortality in children.
- Understanding the clinical features and outcomes is crucial for early diagnosis and intervention.
Purpose of the Study:
- To analyze the clinical features, social circumstances, investigations, and outcomes of children with significant NAHI.
- To identify risk factors and predictors of poor outcomes in pediatric head trauma.
Main Methods:
- Retrospective analysis of 49 children admitted with NAHI between 1979 and 1993.
- Data collected on demographics, clinical presentation (including Glasgow Coma Scale), investigations (CT scans), and outcomes.
Main Results:
- A majority of cases (30/49) were under one year old, with 22 from deprived socioeconomic backgrounds.
- History was incompatible with clinical findings in 44 cases.
- Retinal hemorrhages (28/49) and scalp contusions (35/49) were common; 7 children died, and 19 survivors had severe motor disability.
Conclusions:
- Retinal hemorrhage and unconsciousness (Glasgow Coma Scale ≤ 9) strongly predict poor outcomes.
- Cerebral edema on CT scans is associated with severe motor disability.
- Low socioeconomic status is a significant risk factor for NAHI.
Aims:
To analyse the clinical features, social circumstances, investigations and outcome of 49 children with significant non-accidental head injury admitted to The Prince of Wales Children's Hospital between 1979 and 1993.
Clinical Features:
Age ranged from one month to eight years, with 30 children less than one year old. There were 28 boys and 21 girls. Thirty-three were in the care of a parent. Eleven of these were known to the Department of Community Services and 22 were from families with stressed socioeconomic circumstances characterised by deprivation. In 44 cases the history was incompatible with the clinical findings. On admission, 21 had marked depression of awareness, with a Glasgow Coma Scale score (GCS) of 9 or less. Eleven of this group were fitting. Seizures were present in a further 13 children who were semi-purposeful (GCS > 9). Twenty-eight had retinal haemorrhages and 35 had soft tissue scalp contusions, 23 in association with skull fracture. Twenty-six had associated injuries. Seven children died. Of the 42 survivors at the time of discharge, 19 had severe motor disability associated with other deficits. Twenty-four were returned to the care of their families.
Conclusions:
Retinal haemorrhage and unconsciousness on admission (GCS < or = 9) were positively associated with a poor outcome (P < 0.001 and 0.002, respectively). Cerebral oedema found on computerised tomography was positively associated with severe motor disability on discharge (P < 0.001). Lowest socioeconomic circumstances appeared to be a risk factor for occurrence of injury: 22 of 49 children came from circumstances of deprivation.