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Subdural hematomas in children under 2 years. Accidental or inflicted? A 10-year experience
Insights
Nonaccidental injury is the leading cause of subdural hematomas in young children. Key indicators include retinal hemorrhages, bone fractures, and delayed medical presentation, suggesting child abuse.
Area of Science:
- Pediatric Medicine
- Forensic Pathology
- Child Abuse Research
Background:
- Subdural hematomas (SDHs) in young children can result from abuse, accidents, or disease.
- Distinguishing the etiology of SDHs is crucial for appropriate medical and legal intervention.
Purpose of the Study:
- To determine the relative frequency of child abuse, accidents, and disease as causes of SDHs in children under two years.
- To identify key clinical features that differentiate these etiological groups.
Main Methods:
- Retrospective review of medical records for children under two years with SDH diagnosis.
- Study period: January 1987 to December 1996 at the Royal Alexandra Hospital for Children.
Main Results:
- Nonaccidental injury (NAI) was the most frequent cause (55%), followed by accidents (39%) and nontraumatic causes (6%).
- Abused children were significantly younger and presented with a higher incidence of retinal hemorrhages and fractures (long bone, rib).
- Delayed presentation for medical evaluation was more common in the NAI group.
Conclusions:
- Nonaccidental injury is the predominant cause of subdural hematomas in children under two years.
- Clinical signs such as retinal hemorrhages, bone fractures, delayed presentation, and young infant age strongly suggest child abuse.
Objective:
The aim of this study was to determine the relative frequency of child abuse, accidents and disease as a cause of subdural hematomas in children under 2 years of age, and to determine the main clinical features at presentation, that may help to distinguish these groups of patients.
Method:
A retrospective review was undertaken of the medical records of all children under 2 years of age admitted to the Royal Alexandra Hospital for Children with the diagnosis of subdural hematoma in the 10-year period January 1987 to December 1996.
Results:
Thirty eight children were identified with subdural hematomas during the study period. The commonest cause was nonaccidental injury in 55% of cases, accidents in 39% and nontraumatic causes (6%) made up the remainder. The nonaccidental injury cases were significantly younger than the accidentally injured children. The most important clinical features were the significantly higher incidence of retinal hemorrhages and associated long bone and rib fractures in the abuse group. Delay in presentation for medical evaluation was also more commonly seen in the abused children.
Conclusion:
Nonaccidental injury is the commonest cause of subdural hematomas in children under 2 years of age. The presence of retinal hemorrhages, bone and rib fractures, delay in presentation and the young age of the infants, suggests child abuse is the most likely cause of these injuries.