Intracranial hemorrhage in children younger than 3 years: prediction of intent.

OBJECTIVE: To determine whether certain computed tomographic imaging patterns in infants and young children with intracranial hemorrhage help predict intentional compared with unintentional injuries.
DESIGN: Retrospective consecutive case series over a 10-year period. PATIENTS: Two hundred ninety-three children younger than 3 years with intracranial hemorrhage. MAIN OUTCOME MEASURES: The sensitivity and specificity of computed tomographic imaging patterns for intentional head injury.
SETTING: Regional pediatric medical center.
RESULTS: Four variables used in the multiple logistic regression analysis for predicting intentional head injury were statistically significant (P<.05): subdural hematoma located over the cerebral convexities, hematoma within the interhemispheric subdural space, hygroma (nonhemic subdural fluid) with intracranial hemorrhage, and absence of a skull fracture with intracranial hemorrhage. The prediction model for the diagnosis of intentional head trauma using combinations of these 4 variables and a.45 probability cutoff point indicated a sensitivity of 84% (95% confidence interval, 78%-90%) and a specificity of 83% (95% confidence interval, 74%-89%).
CONCLUSION: Computed tomographic imaging patterns of intracranial hemorrhage in children younger than 3 years help predict whether the injury was intentional.