PEDIATRICS Vol. 102 No. 2 August 1998, pp. 300-307
Neuroimaging, Physical, and Developmental Findings After Inflicted and Noninflicted Traumatic Brain Injury in Young Children
Received Jul 22, 1997; accepted Jan 7, 1998.
,
From the Departments of * Pediatrics and Radiology,
University of Texas at Houston Health Science Center; and the
§ Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Objective. To characterize neuroimaging, physical, neurobehavioral, and developmental findings in children with inflicted and noninflicted traumatic brain injury (TBI) and to identify characteristic features of inflicted TBI.
Methods and Patients. Forty children, 0 to 6 years of age, hospitalized for TBI who had no documented history of previous brain injury were enrolled in a prospective longitudinal study. TBI was categorized as either inflicted (n = 20) or noninflicted (n = 20) based on the assessment of hospital and county protective services. Glasgow Coma Scale scores and neonatal history were comparable in both groups.
Outcome Measures. Acute computed tomography/magnetic
resonance imaging studies and physical findings were evaluated. Glasgow Outcome Scale scores, cognitive development, and motor functioning were
assessed an average of 1.3 months after TBI. 
2 analyses
assessed differences in the distribution of findings in the inflicted
and noninflicted TBI groups.
Results. Signs of preexisting brain injury, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly, were present in 45% of children with inflicted TBI and in none of the children with noninflicted TBI. Subdural hematomas and seizures occurred significantly more often in children with inflicted TBI. Intraparenchymal hemorrhage, edema, skull fractures, and cephalohematomas were similar in both groups. Retinal hemorrhage was only identified in the inflicted TBI group. Glasgow Outcome Scale scores indicated a significantly less favorable outcome after inflicted than noninflicted TBI. Mental deficiency was present in 45% of the inflicted and 5% of the noninflicted TBI groups.
Conclusions. Characteristic features of inflicted TBI included acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal hemorrhages, and significantly impaired cognitive function without prolonged impairment of consciousness.
Key words: child abuse, shaken baby syndrome, traumatic brain injury, cognition, outcome, infants, children, neuroimaging, Glasgow Outcome Scale, retinal hemorrhage.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Jenny Preventing head trauma from abuse in infants Can. Med. Assoc. J., March 31, 2009; 180(7): 703 - 704. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Sharma, J. Jelacic, R. Chennuri, O. Chaiwat, W. Chandler, and M. S. Vavilala Incidence and Risk Factors for Perioperative Hyperglycemia in Children with Traumatic Brain Injury Anesth. Analg., January 1, 2009; 108(1): 81 - 89. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Fujiwara, M. Okuyama, and M. Miyasaka Characteristics That Distinguish Abusive From Nonabusive Head Trauma Among Young Children Who Underwent Head Computed Tomography in Japan Pediatrics, October 1, 2008; 122(4): e841 - e847. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ringeisen, C. Casanueva, M. Urato, and T. Cross Special Health Care Needs Among Children in the Child Welfare System Pediatrics, July 1, 2008; 122(1): e232 - e241. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Kivlin, M. L. Currie, V. J. Greenbaum, K. B. Simons, and J. Jentzen Retinal Hemorrhages in Children Following Fatal Motor Vehicle Crashes: A Case Series Arch Ophthalmol, June 1, 2008; 126(6): 800 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. A. Campbell, R. P. Berger, L. Ettaro, and M. S. Roberts Cost-effectiveness of Head Computed Tomography in Infants With Possible Inflicted Traumatic Brain Injury Pediatrics, August 1, 2007; 120(2): 295 - 304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. D. Kellogg and and the Committee on Child Abuse and Neglect Evaluation of Suspected Child Physical Abuse Pediatrics, June 1, 2007; 119(6): 1232 - 1241. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Bonnier, P. Marique, A. Van Hout, and D. Potelle Neurodevelopmental Outcome After Severe Traumatic Brain Injury in Very Young Children: Role for Subcortical Lesions J Child Neurol, May 1, 2007; 22(5): 519 - 529. [Abstract] [PDF]
|
|
|
|
|
|
K. P. Hymel, K. L. Makoroff, A. L. Laskey, M. R. Conaway, and J. A. Blackman Mechanisms, Clinical Presentations, Injuries, and Outcomes From Inflicted Versus Noninflicted Head Trauma During Infancy: Results of a Prospective, Multicentered, Comparative Study Pediatrics, May 1, 2007; 119(5): 922 - 929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. T. Keenan, S. R. Hooper, C. E. Wetherington, M. Nocera, and D. K. Runyan Neurodevelopmental Consequences of Early Traumatic Brain Injury in 3-Year-Old Children Pediatrics, March 1, 2007; 119(3): e616 - e623. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Salehi-Had, J. D. Brandt, A. J. Rosas, and K. K. Rogers Findings in Older Children With Abusive Head Injury: Does Shaken-Child Syndrome Exist? Pediatrics, May 1, 2006; 117(5): e1039 - e1044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Trokel, A. Waddimba, J. Griffith, and R. Sege Variation in the Diagnosis of Child Abuse in Severely Injured Infants Pediatrics, March 1, 2006; 117(3): 722 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. T. Keenan, D. K. Runyan, and M. Nocera Child Outcomes and Family Characteristics 1 Year After Severe Inflicted or Noninflicted Traumatic Brain Injury Pediatrics, February 1, 2006; 117(2): 317 - 324. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Berger, T. Dulani, P. D. Adelson, J. M. Leventhal, R. Richichi, and P. M. Kochanek Identification of Inflicted Traumatic Brain Injury in Well-Appearing Infants Using Serum and Cerebrospinal Markers: A Possible Screening Tool Pediatrics, February 1, 2006; 117(2): 325 - 332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R A Minns Subdural haemorrhages, haematomas, and effusions in infancy Arch. Dis. Child., September 1, 2005; 90(9): 883 - 884. [Full Text] [PDF]
|
|
|
|
|
|
K. M. Barlow, E. Thomson, D. Johnson, and R. A. Minns Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy Pediatrics, August 1, 2005; 116(2): e174 - e185. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. De Bellis The Psychobiology of Neglect Child Maltreat, May 1, 2005; 10(2): 150 - 172. [Abstract] [PDF]
|
|
|
|
|
|
M R Prasad, L A Kramer, and L Ewing-Cobbs Cognitive and neuroimaging findings in physically abused preschoolers Arch. Dis. Child., January 1, 2005; 90(1): 82 - 85. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Kim, R. G. Barr, and M. T. Stein Question From the Clinician: Colic in Nonhumans Pediatr. Rev., December 1, 2004; 25(12): 442 - 444. [Full Text] [PDF]
|
|
|
|
 |
|
 P. E Lantz The evidence base for shaken baby syndrome: Response to Reece et al from 41 physicians and scientists BMJ, September 25, 2004; 329(7468): 741 - 742. [Full Text]
|
|
|
|
|
|
H. T. Keenan, D. K. Runyan, S. W. Marshall, M. A. Nocera, and D. F. Merten A Population-Based Comparison of Clinical and Outcome Characteristics of Young Children With Serious Inflicted and Noninflicted Traumatic Brain Injury Pediatrics, September 1, 2004; 114(3): 633 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. P. Sirotnak, T. Grigsby, and R. D. Krugman Physical Abuse of Children Pediatr. Rev., August 1, 2004; 25(8): 264 - 277. [Full Text] [PDF]
|
|
|
|
|
|
R. M Reece The evidence base for shaken baby syndrome: Response to editorial from 106 doctors BMJ, May 29, 2004; 328(7451): 1316 - 1317. [Full Text] [PDF]
|
|
|
|
 |
|
 H. D'cruz The Social Construction of Child Maltreatment: The Role of Medical Practitioners Journal of Social Work, April 1, 2004; 4(1): 99 - 123. [Abstract] [PDF]
|
|
|
|
|
|
C. Bonnier, M.-C. Nassogne, C. Saint-Martin, B. Mesples, H. Kadhim, and G. Sebire Neuroimaging of Intraparenchymal Lesions Predicts Outcome in Shaken Baby Syndrome Pediatrics, October 1, 2003; 112(4): 808 - 814. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. T. Keenan, D. K. Runyan, S. W. Marshall, M. A. Nocera, D. F. Merten, and S. H. Sinal A Population-Based Study of Inflicted Traumatic Brain Injury in Young Children JAMA, August 6, 2003; 290(5): 621 - 626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Rubin, C. W. Christian, L. T. Bilaniuk, K. A. Zazyczny, and D. R. Durbin Occult Head Injury in High-Risk Abused Children Pediatrics, June 1, 2003; 111(6): 1382 - 1386. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hettler and D. S. Greenes Can the Initial History Predict Whether a Child With a Head Injury Has Been Abused? Pediatrics, March 1, 2003; 111(3): 602 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Tien, H. Bauchner, and R. M. Reece What Is the System of Care for Abused and Neglected Children in Children's Institutions? Pediatrics, December 1, 2002; 110(6): 1226 - 1231. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Blumenthal Shaken baby syndrome Postgrad. Med. J., December 1, 2002; 78(926): 732 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. P. Hymel, C. Jenny, and R. W. Block Intracranial Hemorrhage and Rebleeding in Suspected Victims of Abusive Head Trauma: Addressing the Forensic Controversies Child Maltreat, November 1, 2002; 7(4): 329 - 348. [Abstract] [PDF]
|
|
|
|
|
|
R. D. Pitetti, F. Maffei, K. Chang, R. Hickey, R. Berger, and M. C. Pierce Prevalence of Retinal Hemorrhages and Child Abuse in Children Who Present With an Apparent Life-Threatening Event Pediatrics, September 1, 2002; 110(3): 557 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. W. M. VELTMAN and K. D. BROWNE Three Decades of Child Maltreatment Research: Implications for the School Years Trauma Violence Abuse, July 1, 2001; 2(3): 215 - 239. [Abstract] [PDF]
|
|
|
|
|
|
Committee on Child Abuse and Neglect Shaken Baby Syndrome: Rotational Cranial Injuries{---}Technical Report Pediatrics, July 1, 2001; 108(1): 206 - 210. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. W. Morris, S. Smith, J. Cressman, and J. Ancheta Evaluation of Infants With Subdural Hematoma Who Lack External Evidence of Abuse Pediatrics, March 1, 2000; 105(3): 549 - 553. [Abstract] [Full Text]
|
|
|
|
|
|
M. R. Prasad, L. Ewing-Cobbs, and J. Baumgartner Crush Head Injuries in Infants and Young Children: Neurologic and Neuropsychologic Sequelae J Child Neurol, August 1, 1999; 14(8): 496 - 501. [Abstract] [PDF]
|
|
|
|
|
|
C. Jenny, K. P. Hymel, A. Ritzen, S. E. Reinert, and T. C. Hay Analysis of Missed Cases of Abusive Head Trauma JAMA, February 17, 1999; 281(7): 621 - 626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Lloyd Subdural haemorrhages in infants BMJ, December 5, 1998; 317(7172): 1538 - 1539. [Full Text]
|
|
