INVESTIGATION OF SUSPECTED PAEDIATRIC NON-ACCIDENTAL HEAD INJURY

Objectives: To evaluate how successful the implementation of local best practice non-accidental head injury (NAHI) standards was in a specialist paediatric hospital and to assess the effect these had on the management of children with suspected NAHI.

Methods: Retrospective comparative study of children with suspected NAHI who presented to Great Ormond Street Hospital for Children before and after NAHI best practice standards were implemented. Setting: London specialist paediatric hospital. Subjects: 25 children with suspected NAHI (15 pre and 10 post-standards introduction).

Results: The desired targets for ophthalmology and CT scan assessment were achieved pre and post-standards introduction. Radiological skeletal survey (formal report within 1 working day) improved post-standards introduction (6/15 (40%) versus 8/10 (80%)). MRI scan assessment improved post standards introduction (8/15 (53%) versus 10/10(100%)). Medical investigation NAHI work-up was more complete post-standards introduction (7/15 (47%) versus 8/10 (80%)). Additional diagnostic information was obtained from children who had subsequent MRI scan as part of their NAHI work-up in 10/12 (83%) children. These findings include extension of the acute subdural haemorrhage (SDH) in 8/12 (67%), chronic SDH in 2/12 (17%), focal brain parenchymal injury in 2/12 (17%) and extension of brain parenchymal injury in 3/12 (25%) children.

Conclusion: A local best practice standards approach has improved the quality of care and service provision of children with suspected NAHI. Early MRI scan as part of the NAHI work-up is crucial in the investigation of NAHI as it improves the diagnosis of causation. Implementation of NAHI best practice standards can be achieved in a specialist centre. We recommend a similar structured approach in other specialist centres.