gms | German Medical Science

Objective: To analyse the clinical and radiological findings and the late outcome in pediatric non-accidental head injury (NAHI).

Methods: The charts of all children <6 years admitted to the service following head injury within a five-year period of time were reviewed for evidence of non-accidental trauma. Clinical status and radiological findings on admission and the further course were assessed. Information on late outcome was obtained by follow-up examination on an outpatient basis.

Results: Among a total of n=93 children <6 years of age admitted within a five-year period of time following head injury, n=9 (10%) with an age of 2 weeks – 12 months (mean: 5.3 months) were diagnosed for having suffered from NAHI. Seven were male and two female. Bihemispheric chronic subdural hematomas (cSDH) with additional unilateral acute components were found in n=7 (78%) with one child suffering from an additional interhemispheric hematoma. One patient had exclusively bihemispheric chronic subdural hematomas, another one had brain edema, subarachnoid and intracerebral hemorrhage. Subretinal bleeding was present in all. Diffusion-weighted and T2 MRI-sequences revealed pattern-like biparietooccipital hyperintense subcortical white matter changes in n=7 children. Chronic and acute SDH were drained in n=7 patients. The department of forensic medicine confirmed the suspicion of child abuse in all patients. After a mean of 35,7 (2 – 84) months after the trauma, n=3 children lived with their parents under institutional supervision and without evidence for further NAHI, n=5 lived with foster parents or in children's homes, one patient is still hospitalized. Five patients developed symptomatic seizures requiring antiepileptic therapy, n=2 show severe psychomotor retardation without the ability to communicate or to walk by themselves. Four children developed according to their age so far.

Conclusions: The rate of NAHI among a cohort of children <6 years suffering from head injury is as high as ten percent, and thus cannot be overestimated. For the sake of the safety of these children, it is important to rule out NAHI by supplementary investigations in case of suspicious findings such as bilateral chronic subdural hematoma. MRI shows pathognomonic features attributable to extreme shearing forces. It is advised to follow a strict algorithm of patient care, including regular clinical and MRI follow-up, as many of these children suffer from psychomotor retardation and from epilepsy.