Related Experiment Videos
Subdural haemorrhages in infants: population based study
S Jayawant1, A Rawlinson, F Gibbon
1Department of Child Health, University of Wales College of Medicine, Academic Centre, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX.
Insights
Subdural haemorrhage is common in infants, often resulting from child abuse and leading to poor outcomes. Investigations are frequently inadequate, highlighting the need for thorough assessments in suspected cases.
Area of Science:
- Pediatric Neurology
- Child Abuse Forensics
- Public Health
Background:
- Subdural haemorrhage (SDH) in young children is a serious condition.
- Understanding its incidence, causes, and outcomes is crucial for timely intervention.
Purpose of the Study:
- To determine the incidence and clinical outcomes of SDH in children under two years.
- To identify factors associated with SDH, including child abuse.
- To evaluate the adequacy of investigations in these cases.
Main Methods:
- A population-based case series was conducted in South Wales and South West England.
- Included children under two years with SDH, excluding those with neonatal unit complications, infection, or post-neurosurgery SDH.
- Analyzed incidence, clinical outcomes, investigation protocols, and risk factors, particularly child abuse.
Main Results:
- The incidence of SDH was 12.8/100,000 children/year, higher in infants under one year (21.0/100,000).
- Outcomes were poor, with 9 deaths and 15 profound disabilities among 33 cases.
- 82% of cases were highly suggestive of abuse, yet only 22 infants received comprehensive investigations.
Conclusions:
- SDH is prevalent in infancy with a high mortality and disability rate.
- Child abuse is the primary cause, though some cases remain unexplained.
- Inconsistent and inadequate investigations necessitate standardized, multidisciplinary assessments for suspected SDH in children.
Objectives:
To identify the incidence, clinical outcome, and associated factors of subdural haemorrhage in children under 2 years of age, and to determine how such cases were investigated and how many were due to child abuse.
Design:
Population based case series.
Setting:
South Wales and south west England.
Subjects:
Children under 2 years of age who had a subdural haemorrhage. We excluded neonates who developed subdural haemorrhage during their stay on a neonatal unit and infants who developed a subdural haemorrhage after infection or neurosurgical intervention.
Main Outcome Measures:
Incidence and clinical outcome of subdural haemorrhage in infants, the number of cases caused by child abuse, the investigations such children received, and associated risk factors.
Results:
Thirty three children (23 boys and 10 girls) were haemorrhage. The incidence was 12.8/100 000 children/year (95% confidence interval 5.4 to 20.2). Twenty eight cases (85%) were under 1 year of age. The incidence of subdural haemorrhage in children under 1 year of age was 21.0/100 000 children/year and was therefore higher than in the older children. The clinical outcome was poor: nine infants died and 15 had profound disability. Only 22 infants had the basic investigations of a full blood count, coagulation screen, computed tomography or magnetic resonance imaging, skeletal survey or bone scan, and ophthalmological examination. In retrospect, 27 cases (82%) were highly suggestive of abuse.
Conclusion:
Subdural haemorrhage is common in infancy and carries a poor prognosis; three quarters of such infants die or have profound disability. Most cases are due to child abuse, but in a few the cause is unknown. Some children with subdural haemorrhage do not undergo appropriate investigations. We believe the clinical investigation of such children should include a full multidisciplinary social assessment, an ophthalmic examination, a skeletal survey supplemented with a bone scan or a skeletal survey repeated at around 10 days, a coagulation screen, and computed tomography or magentic resonance imaging. Previous physical abuse in an infant is a significant risk factor for subdural haemorrhage and must be taken seriously by child protection agencies.