Published online September 1, 2004
PEDIATRICS Vol. 114 No. 3 September 2004, pp. 633-639 (doi:10.1542/peds.2003-1020-L)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (21)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Keenan, H. T.
Right arrow Articles by Merten, D. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Keenan, H. T.
Right arrow Articles by Merten, D. F.

A Population-Based Comparison of Clinical and Outcome Characteristics of Young Children With Serious Inflicted and Noninflicted Traumatic Brain Injury

Heather T. Keenan, MDCM, MPH*,{ddagger}, Desmond K. Runyan, MD, DrPH*,{ddagger},§, Stephen W. Marshall, PhD{ddagger},||,¶, Mary Alice Nocera, RN, MSN{ddagger} and David F. Merten, MD#

* Department of Social Medicine
{ddagger} Injury Prevention Research Center
§ Department of Pediatrics
|| Department of Epidemiology
Department of Orthopedics
# Department of Radiology, University of North Carolina, Chapel Hill, North Carolina

Objective. Diagnosing inflicted traumatic brain injury (TBI) in young children is difficult in practice. Comparisons of children with inflicted and noninflicted TBI may help to identify markers of inflicted TBI. The objective of this study was to compare inflicted and noninflicted TBI in terms of presenting complaints, clinical features, and hospital outcomes.

Methods. The presenting complaint, clinical finding, hospital course, and outcome of all children who were aged 2 years or younger in North Carolina and were admitted to a pediatric intensive care unit or died with a TBI in 2000 and 2001 were reviewed. Clinical presentation and injury types were compared between children with inflicted and noninflicted TBI. Risk ratios were used to compare clinical and outcome characteristics between the 2 groups. Among survivors, multivariate binomial regression was used to examine the adjusted risk of a poor outcome dependent on injury type.

Results. A total of 80 (52.6%) children had inflicted and 72 (47.3%) children had noninflicted TBI. Children with noninflicted TBI (not in a motor vehicle crash) were more likely to present to the emergency department asymptomatic (44.8% vs 8.3%) and to have a specific history of trauma than children with inflicted TBI. Retinal hemorrhage, metaphyseal fracture, rib fracture, and subdural hemorrhage were more commonly found in children with inflicted compared with noninflicted TBI. Skeletal survey and ophthalmologic examination combined would have missed 8 (10.0%) inflicted TBI cases.

Conclusions. Manner of presentation and injury types are helpful in distinguishing inflicted TBI. Clinicians should not rule out inflicted TBI on the basis of skeletal survey and ophthalmoscopy alone but should proceed to computed tomography and/or magnetic resonance imaging.

Key Words: child abuse • traumatic brain injury • shaken baby syndrome

Abbreviations: TBI, traumatic brain injury • PICU, pediatric intensive care unit • CT, computed tomography • MRI, magnetic resonance imaging • OCME, Office of the Chief Medical Examiner • CPR, cardiopulmonary resuscitation • GCS, Glasgow Coma Score • POPC, Pediatric Outcome Performance Category • RR, risk ratio • MVC, motor vehicle crash • CI, confidence interval

Accepted Mar 11, 2004.




This article has been cited by other articles:


Home page
 PediatricsHome page
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]

Home page
 PediatricsHome page
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]

Home page
 Arch. Dis. Child.Home page
S. Jayawant and J. Parr
Outcome following subdural haemorrhages in infancy
Arch. Dis. Child., April 1, 2007; 92(4): 343 - 347.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
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]

Home page
 PediatricsHome page
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]

Home page
 PediatricsHome page
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]

Home page
 AAP Grand RoundsHome page
S. L. Bratton
Traumatic Brain Injury in Children
AAP Grand Rounds, December 1, 2004; 12(6): 71 - 71.
[Full Text] [PDF]