Abusive head trauma is a often met...

Abusive head trauma is a often met with cause of death and traumatic brain injury in young children. Comput tomographic (CT) scanning and magnetic resonance imaging (MRI) can identify children who have put up withed abusive head trauma, but identifying children who ne these studies is repeatedly difficult. When clear signs of inflicted head trauma are not past nor future investigation is certainly indicated. In the absence of clear evidence, however, it is more difficult to determine when imaging is appropriate. Laskey and associates reviewed the passing from hand to hand standards of evaluation for abusive head trauma among children with suspected physical abuse as evidenced according to an order for a skeletal survey

The authors reviewed the medical records of 51 children up to to 48 month of age who had skeletal inspects for suspected abuse and who had no evidence of head trauma. consequences examined included the following: (1) imaging by the agency of CT or MRI; (2) dilated fundoscopic examination performed on an ophthalmologist; and (3) any positive consequence s from these diagnostic procedures.

Twenty-four of the 51 children evaluated (47 percent) had a fracture identified forward the skeletal survey, most commonly an arm fracture. Thirty-eight (75 percent) had neuroimaging; 11 of these (29 percent) demonstrated an intracranial injury of that kind as a subdural hematoma, cerebral hematoma, or epidural hematoma. Opthalmology deliberates were performed on 35 patients (69 percent) with retinal hemorrhage identified in common child (3 percent). The sole factor significantly related to ordering neuroimaging or oph-thalmologic examination was an age younger than 12 month Children in this age assign places to had more frequent evaluations for intracranial trauma than children older than 12 months

The authors bring to an end that evidence is still lacking about the most numerous appropriate use of neuroimaging in many asymptomatic younger children with suspected physical abuse. They make acceptable that physicians consider MRI as the better imaging choice because of greater accuracy for the variety of potential traumatic injuries and because of the attention focused forward the potential danger of cancer later in life among children undergoing CT They add that dilated fundoscopic examination is a safe alternative, however that reliance on retinal hemorrhage as a criterion for head trauma would miss a large number of children with mystical intracranial injuries. Further studies are extremityed to guide the most appropriate use of neuroimaging in the evaluation of asymptomatic young children who may have been physically abused.

RICHARD SADOVSKY, MD

Laskey AL, et al. undetected head trauma in young suspected victims of physical abuse. J Pediatr June 2004;144:719-22

COPYRIGHT 2005 American Academy of Family Physicians

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