Published online September 1, 2008
PEDIATRICS (doi:10.1542/peds.2008-0387)
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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.