Published online September 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. e841-e847 (doi:10.1542/10.1542/peds.2008-0387)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters 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 arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fujiwara, T.
Right arrow Articles by Miyasaka, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fujiwara, T.
Right arrow Articles by Miyasaka, M.
Related Collections
Right arrow Surgery
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Characteristics That Distinguish Abusive From Nonabusive Head Trauma Among Young Children Who Underwent Head Computed Tomography in Japan

Takeo Fujiwara, MD, PhD, MPHa,b,c, Makiko Okuyama, MD, PhDc and Mikiko Miyasaka, MDd

a Section of Behavioral Science, Department of Health Promotion and Research, National Institute of Public Health, Saitama, Japan
b Centre for Community Child Health Research, Child and Family Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Departments of c Psychosocial Medicine
d Radiology, National Center for Child Health and Development, Tokyo, Japan

OBJECTIVE. Distinguishing abusive head trauma in young children from other diseases by symptoms is difficult in practice. Comparisons between abusive and nonabusive head trauma in young children in Japan, where computed tomography is widely and easily available, might contribute to identifying markers of abusive head trauma that differ from that in Western countries. The objective of this study was to compare the characteristics of abusive and nonabusive head trauma in young children in Japan.

METHODS. A comparative case series study involving a retrospective medical chart and social work record review of children who were aged 0 to 2 years, visited the National Center for Child Health and Development (Tokyo, Japan) from March 1, 2002, to December 31, 2005, and underwent computed tomography scanning because of suspected intracranial injury was performed. Patients (N = 260) were identified and classified as having either abusive or nonabusive head trauma on the basis of the published definition. Demographic and perinatal characteristics, injury history, clinical presentation, and outcomes were compared by using {chi}2 and Fisher's exact tests.

RESULTS. Patients with abusive head trauma were significantly younger than patients with nonabusive head trauma and had a peak at ~2 to 4 and 7 to 9 months. Patients with abusive head trauma more likely presented no injury history by the caregiver, neurologic symptoms (unconsciousness, seizure, paralysis), subdural hemorrhage, and retinal hemorrhages. Although patients with abusive head trauma had severe clinical outcomes, only 32% of them were separated from the caregiver by social welfare services.

CONCLUSIONS. This study highlights the several clinical markers to detect abusive head trauma at a medical visit, including an absence of injury history, neurologic symptoms, subdural hemorrhage, and retinal hemorrhage. These markers can be used to detect abusive head trauma cases by physicians and social welfare workers to protect children from additional abuse.

Key Words: child abuse • shaken baby syndrome • craniocerebral trauma • abusive head trauma • traumatic brain injury

Abbreviations: AHT—abusive head trauma • SDH—subdural hemorrhage • CT—computed tomography • CGC—Child Guidance Center

Accepted Jun 18, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 BMJHome page
J. S Radesky and N. F Sugar
Femur fracture in an infant
BMJ, May 13, 2009; 338(may13_2): b1583 - b1583.
[Full Text]