Archives of Disease in Childhood | 2019
G94(P)\u2005Brain injury screening in suspected physical abuse: time to rethink
Abstract
Aims CT head is recommended for all children<1\u2009year-of-age with suspected physical abuse. To assess diagnostic yield of CT brain in children under 2y presenting with suspected physical abuse. We specifically looked at associations between clinical presentation, haemoglobin and CT findings. Methods Retrospective case note review of all children under 2y who underwent child protection Medical’s for suspected physical abuse between 2009 and 2017 in a single University hospital Board. Data analysed included CT head findings, Haemoglobin and clinical presentation (table 1). Results A total of 536 cases were identified (M:F 3:2), 323 (60%) were infants<1\u2009year of age. 172/323 (53.3%) of infants had CT scan 42 (24.4%) were positive (7 skull fracture, 16 extradural haemorrhage, 13 extradural and skull fracture, 7 other findings); 18/213 (8.5%) of 1-year-olds had a CT 9 (50%) were positive (2 skull fracture, 7 intracranial injury).Abstract G94(P) Table 1 Describes the proportion of abnormal CT in 190 children who presented with specific clinical presentations and had head CT imaging Proportion and frequency of abnormal CT Odds ratio (95%\u2009CI ) for positive CT Head swelling 92% (12/13) 44.1 (5.5–349) Neurological impairment/death 85% (22/26) 24.6 (7.9–76.6) Low Haemoglobin 54% (29/54) 5.6 (2.7–11.4) History of fall or physical assault 35% (5/15) 1.4 (0.4–4.2) Head/neck bruising 13% (9/69) 0.3 (0.1–0.6) Bruise/bite/burn or cutaneous injury other than to head/neck 2% (1/43) 0.05 (0.006–0.3) Long bone or rib fracture 0% (0/9) N/A Abuse of sibling 0% (0/5) N/A Other as yet unknown 33% (3/9) tbc Conclusion Swelling to the head, neurological impairment and low haemoglobin were significantly associated with positive findings on head CT in children assessed for suspected physical abuse, with positive CT in 13% and 35% of children with a history of a fall/physical assault or head/neck bruising respectively. These findings warrant further discussion regarding current guidance modification and radiation exposure for CT in infants particularly those with injuries unrelated to the head and normal haemoglobin.