BACKGROUND: The diagnosis of inflicted head injury (IHI) or accidental trauma (AT) in infants is based on clinical, radiological, and/or ophthalmological findings such as subdural hematoma (SDH), encephalopathy, retinal hemorrhage (RH), and signs of impact. As a consequence, the diagnostic value of these criteria is difficult to assess because of a circularity bias. PURPOSE: In order to assess the predictive value of these diagnostic criteria avoiding circularity, we studied prospectively corroborated cases of head injuries in infants, comparing IHI with AT. MATERIAL AND METHODS: We selected 45 cases of confessed IHI and 39 cases of AT having occurred in public places. Patients were systematically evaluated clinically, with computed tomography scanner and ophthalmological evaluation by a trained ophthalmologist. RH was rated as absent, mild, and severe, according to the depth and extent of the RH. RESULTS: Brain ischemia was found in 26.7% of IHI; the most prominent elements in favor of IHI were SDH, severe RH, and absence of signs of impact; the predictive diagnostic values of these three features were 0.685, 0.961, and 0.830, respectively; however, only severe RH in the absence of ocular impact was specific of IHI. When all three features were combined, the specificity was 100%, but the sensitivity was only 24.4%. CONCLUSION: Our study confirms the high diagnostic value of RH, SDH, and signs of impact for the differential diagnosis between AT and IHI. The evaluation of head injuries in infants requires a high level of awareness and thorough and systematic examination by a trained multidisciplinary team.
BACKGROUND: The diagnosis of inflicted head injury (IHI) or accidental trauma (AT) in infants is based on clinical, radiological, and/or ophthalmological findings such as subdural hematoma (SDH), encephalopathy, retinal hemorrhage (RH), and signs of impact. As a consequence, the diagnostic value of these criteria is difficult to assess because of a circularity bias. PURPOSE: In order to assess the predictive value of these diagnostic criteria avoiding circularity, we studied prospectively corroborated cases of head injuries in infants, comparing IHI with AT. MATERIAL AND METHODS: We selected 45 cases of confessed IHI and 39 cases of AT having occurred in public places. Patients were systematically evaluated clinically, with computed tomography scanner and ophthalmological evaluation by a trained ophthalmologist. RH was rated as absent, mild, and severe, according to the depth and extent of the RH. RESULTS:Brain ischemia was found in 26.7% of IHI; the most prominent elements in favor of IHI were SDH, severe RH, and absence of signs of impact; the predictive diagnostic values of these three features were 0.685, 0.961, and 0.830, respectively; however, only severe RH in the absence of ocular impact was specific of IHI. When all three features were combined, the specificity was 100%, but the sensitivity was only 24.4%. CONCLUSION: Our study confirms the high diagnostic value of RH, SDH, and signs of impact for the differential diagnosis between AT and IHI. The evaluation of head injuries in infants requires a high level of awareness and thorough and systematic examination by a trained multidisciplinary team.
Authors: L Ewing-Cobbs; L Kramer; M Prasad; D N Canales; P T Louis; J M Fletcher; H Vollero; S H Landry; K Cheung Journal: Pediatrics Date: 1998-08 Impact factor: 7.124
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Authors: Amaka C Offiah; Sabah Servaes; Catherine S Adamsbaum; Maria I Argyropoulou; Katharine E Halliday; Tim Jaspan; Catherine M Owens; Maria Raissaki; Karen Rosendahl; Neil Stoodley; Rick R Van Rijn; Michael J Callahan; Taylor Chung; James S Donaldson; Diego Jaramillo; Thomas L Slovis; Peter J Strouse Journal: Pediatr Radiol Date: 2017-02-23
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Authors: Brittany Coats; Gil Binenbaum; Colin Smith; Robert L Peiffer; Cindy W Christian; Ann-Christine Duhaime; Susan S Margulies Journal: J Neurotrauma Date: 2016-05-11 Impact factor: 5.269