Rubaraj Jayarajasingam MBBS, Presenter: Nothing to Disclose

Smitha Rajaram MBBS, Abstract Co-Author: Nothing to Disclose

Ashok Raghavan BA, Abstract Co-Author: Nothing to Disclose

Alan Sprigg MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

Paul David Griffiths MBChB, Abstract Co-Author: Research grant, General Electric Company Research grant, PMS

Daniel Connolly MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

The imaging of children with suspected non-accidental head injury (NAHI) is critical in the diagnosis of injuries and predicting the longer term morbidity. Imaging is also vital in criminal prosecution court cases. The radiologist must ensure the child is imaged by the appropriate modality and at the optimal time to diagnose injuries correctly. Jaspan et al proposed a protocol for the initial and follow up neuro-imaging of children with suspected NAHI. We assessed our compliance with these guidelines.

A retrospective case note review of the imaging undertaken for thirteen consecutive cases of suspected NAHI presenting to our large paediatric teaching hospital between 2006 and 2007. We reviewed the timing and modality of all neuro-imaging which each child received. CT imaging was expected at days 1, 3 and 10. MR imaging was expected at days 3 and 60. Set imaging protocols for CT and MR were expected to be completed.

Thirteen children (7 male:6 female) were recruited into the study with ages ranging from 24 days to 26 months. There were no mortalities during the study period. Compliance with the protocol was as follows; Day 1 CT 9 cases (69%), Day 3 CT 2 cases (15%), Day 10 CT 1 case (7%). Day 3 MRI 4 cases (31%), Day 60 MRI 0 cases (0%). CT scans at presentation showed 61% had subdural haemorrhage, 20% had a subarachnoid haemorrhage, 20% had a skull fracture, 7% had an extra-dural haemorrhage and 7% had diffuse axonal injury. When requested all the imaging was undertaken at the appropriate time, the images were of adequate quality, and scans were all reported within 48 hours.

The study shows the amount of follow up imaging for suspected NAHI is inconsistent and inadequate. Radiologists and Paediatricians need to formally agree a policy to image children who suffer NAHI and work closely together in order to ensure that all imaging is obtained. Radiologists should be more proactive in ensuring that the imaging which they may rely upon in court is obtained in order to allow them to provide appropriate advice. References : Neuro-imaging for non accidental head injury in children: A proposed protocol. Jaspan T.; Griffiths P.D.; McConachie N.S.; Punt J.A.G. Clinical Radiology pp. 44-53(10).

Radiologist must ensure satisfactory imaging of children with suspected non accidental head injury as it is imperative for accurate diagnosis and predicting long term morbidity.

Jayarajasingam, R, Rajaram, S, Raghavan, A, Sprigg, A, Griffiths, P, Connolly, D, Cranial Imaging of Children with Suspected Non Accidental Head Injuries: Do We Comply with Guidelines on Follow-up Imaging?.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6017969.html