Glenn Albert Tung MD, Abstract Co-Author: Nothing to Disclose

Monica Kumar BA, Presenter: Nothing to Disclose

William Douglas Brown MD, Abstract Co-Author: Nothing to Disclose

Carole Jenny, Abstract Co-Author: Nothing to Disclose

Randall Richardson, Abstract Co-Author: Nothing to Disclose

Mixed-density subdural hematoma (SDH), perifalcine hemorrhage, and retinal hemorrhage are suggestive of inflicted, nonaccidental head trauma (NAHT). The purpose of this study is to investigate SDH on NCCT and retinal hemorrhage (RH) in infants with NAHT, and to compare these findings in infants with accidental head injury (AHI) for whom the date of injury was corroborated.

Two blinded, independent observers retrospectively reviewed (1) NCCT performed on the day of presentation on 9 infant victims of NAHT (mean age, 7.1 months; range, 1-25 months) with SDH, and (2) NCCT performed within 24 hours of injury on 38 infants (mean age, 4.8 months; range, newborn-34 months) with SDH and AHI (birth-related, 19; short fall, 17; motor vehicle accident, 2). Fundoscopy reports were also reviewed.

Although more prevalent in cases of NAHT, there was no statistically significant difference in the proportion of cases with mixed-density SDH [NAHT 5/9 (56%); AHI, 9/38 (24%); p=.25]. There was also no statistically significant difference in proportion of cases with perifalcine hemorrhage [NAHT 3/9 (33%); AHI, 9/38 (24%); p=.67]; hyperdense SDH [NAHT, 3/9 (33%); AHI, 26/38 (68%); p=.068]; epidural hematoma [NAHT 3/9 (33%); AHI, 4/38 (11%); p=.12]; calvarial fracture [NAHT 1/9 (11%); AHI, 16/38 (42%); p=.18]; brain contusion [NAHT 1/9 (11%); AHI, 7/38 (18%); p=1.0], or subarachnoid hemorrhage [NAHT 0/9; AHI, 4/38 (11%); =.57]. However, retinal hemorrhage was significantly more common in cases of NAHT [NAHT, 5/9 (56%); non-birth related AHI, 1/9 (5%); p=.0005].

Mixed-density subdural hematoma may be found on NCCT performed within 24 hours of accidental head injury. Neither mixed-density SDH nor perifalcine hemorrhage is a specific indicator of NAHT. Although retinal hemorrhage can occur after accidental head injury, it is significantly more common after nonaccidental head trauma.

Tung, G, Kumar, M, Brown, W, Jenny, C, Richardson, R, Comparison of Accidental and Nonaccidental Traumatic Head Injury in Children on Noncontrast Computed Tomography.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4411386.html