Abuse (Nonaccidental Trauma)

Nonaccidental Trauma

1. abusive head trauma most common cause of traumatic death in infants
2. risk factors for abuse
   1. infant
   2. lower status
   3. family problems
   4. disability or prematurity of infant
3. historical alternans, or may present with medical complaints like irreg breathing, apnea, sz, irritable, lethargic, vomiting, poor feeding
4. retinal hem usually from abuse may rarely be from other trauma
5. most common abusive lesions are
   1. SAH
   2. subdural
   3. interhemispheric blood
   4. cerebral edema
   5. same lesion not common with accidental trauma but possible
6. fx assoc with abuse are multiple, bilateral, cross sutures, diastatic, nonparietal, assoc with subdural
7. skull fx from short fall <3 ft usually linear

Recommendations

1. ct if ams
2. consider ct if h/o loc, amnesia, sz, HA, vomiting, irritable, behavioral change
3. if mild sxs, no ct but observe
4. lower threshold if young <1-2 yrs since skull fx more common and more risk for abuse
5. image if significant scalp findings
6. consider abuse if no hx of trauma, delay in seeking care, changing story, repeated injuries, mismatch of hx with physical exam, wounds of diff stages of healing
7. call neurosurg if intracranial inj, skull fx depressed or widely diastatic

• MADNATORY REPORTING if there is any suspicion, for details check your state's guidelines.
  • If you are suspicious, cannot discharge patient home unless you can guarantee a safe environment.

See also

• Head CT (Peds)
• Sexual Assault

Source

Adapted from Pani