Abusive Head Trauma: Epidemiological Aspects and Diagnosis

Abstract

Objective Abusive head trauma (AHT) is defined as a severe, non-accidental traumatic brain injury. Early recognition and treatment are instrumental in limiting the immediate complications and long-term disabilities. The goal of this study was to describe our experience with traumatic head injuries in children younger than 2 years of age.

Methods We reviewed the medical records of 195 children aged under 2 years with suspected AHT who presented with a head injury without witnessed accidental trauma, between January 2008 and June 2013.

Results AHT was considered in 145 children. Familial problems (ρ = 0.008), cutaneous hematoma/bruising (ρ < 0.001), retinal hemorrhages (ρ < 0.001), and bone fractures (ρ = 0.04), were significantly more frequent in the AHT group.

Conclusions The association between the subdural hematoma and retinal hemorrhage, resulting from an unwitnessed and incoherent history of trauma, is a strong argument for AHT, particularly when associated lesions and socioeconomic risk factors are evident.

Resumo

Objetivo O traumatismo craniano por abuso (AHT) é definido como uma grave lesão cerebral traumática não acidental. O reconhecimento e tratamento precoce são fundamentais para limitar as complicações imediatas e sequelas tardias. O objetivo deste estudo foi descrever a nossa experiência em crianças menores de 2 anos de idade, vítimas de trauma craniano.

Métodos Foram revisados os prontuários de 195 crianças com idade inferior a 2 anos com suspeita de AHT, sem trauma acidental testemunhado e com diagnostico de hematoma subdural, entre janeiro de 2008 e junho de 2013.

Resultados AHT foi considerado em 145 crianças. Problemas socioeconômicos familiares (ρ = 0,008), hematomas e lesões cutâneas (ρ <0,001), hemorragias retinianas (ρ <0,001), e fraturas em ossos longos (ρ = 0,04), foram significativamente mais frequentes no grupo de crianças com suspeita de AHT.

Conclusões A associação entre hematomas subdurais e hemorragia retiniana, resultante de uma história incoerente de trauma sem testemunhas, é um forte argumento para a AHT, particularmente quando lesões cutâneas e fatores de risco socioeconômicos forem identificados.

Keywords

brain injuries - child abuse - shaken baby syndrome - subdural hematoma

Palavras-chave

traumatismos encefálicos - maus-tratos infantis - síndrome do bebê sacudido - hematoma subdural

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