TABLE 1

Identified Cases in Which Diagnosis of Intracranial Hemorrhage Was Delayed (>6 Hours After Reported Injury)

TypeAgeGenderMechanism of InjuryPrevious EvaluationTime to DiagnosisICH
TypeSeverityLocation
DDIH with decreased level of consciousness7 yMaleRan into cement wall and hit headNon-CHR ED38 hEpiduralModerateTemporoparietal
3 yFemaleFell down stairs, >3 ftNone8 hIntracerebralLargeCerebellar
DDIH without decreased level of consciousness13 yFemaleTripped on cement floor and hit headClinic12 hEpiduralModerateParietal
6 yFemaleFell from father's arms onto iceCHR ED21 hEpiduralSmallFrontal
11 yFemaleFell from horse onto groundCHR ED8 hSubduralSmallPosterior fossa
7 yMaleFell off playground equipment onto ground, >3 ftCHR ED23 hEpiduralLargeFrontal
3 yFemaleFell off play wagon and hit head on groundCHR ED6 dEpiduralUnknownParietooccipital
17 dMaleFell from mother's arms onto cement floorNone13 hEpiduralSmallParietal
4 yMaleWhile sledding, hit head on postNone7 hEpiduralSmallFrontal
3 yMaleFell from shopping cart, >3 ftCHR ED21 hEpiduralSmallTemporooccipital
NATa2 yMaleShaking injuryNoneUnknownChronic subduralLargeDiffuse
7 yMalePhysical assault by motherNoneUnknownChronic subduralSmallMidbrain
6 moFemaleShaking injuryClinicUnknownSubduralSmallFrontal
2 yMaleNATNoneUnknownIntracerebralUnknownTemporoparietal
DIb4 yMaleWhile sledding, hit head on postNone7 hEpiduralSmallFrontal
2 yMaleSingle car rollover in car seatCHR ED7 hIntraventricularSmallLateral ventricle
ICH?c5 yMaleTripped and hit head on concrete floorNone16 hSubduralNot applicableOcciput
  • DDIH indicates delayed diagnosis of intracranial hemorrhage; CHR, Calgary Health Region; NAT, nonaccidental trauma; DI, delayed imaging; ICH, intracranial hemorrhage.

  • a Initial history findings provided by the parents suggested that the child had delayed diagnosis of intracranial hemorrhage, but subsequent evaluation revealed that the cause of brain injury was nonaccidental trauma, the timing of which was unclear.

  • b The potential for intracranial hemorrhage was recognized at <6 hours but imaging was delayed to >6 hours.

  • c Independent, blinded review by neurosurgeons suggested that the reported intracranial hemorrhage was attributable to an imaging artifact and did not represent true intracranial hemorrhage.