Abuse (Nonaccidental Trauma)

NONACCIDENTAL TRAUMA

- abusive head trauma most common cause of traumatic death in infants

- risk factors for abuse

• infant
• lower status
• family problems
• disability or prematurity of infant

- historical alternans, or may present with medical complaints like irreg breathing, apnea, sz, irritable, lethargic, vomiting, poor feeding

- retinal hem usually from abuse may rarely be from other trauma

- most common abusive lesions are

• subarach hem
• subdural
• interhemispheric blood
• cerebral edema
• same lesion not common with accidental trauma but possible

- fx assoc with abuse are multiple, bilateral, cross sutures, diastatic, nonparietal, assoc with subdural

- skull fx from short fall <3 ft usually linear

Recommendations

- ct if ams

- consider ct if h/o loc, amnesia, sz, HA, vomiting, irritable, behavioral change

- if mild sxs, no ct but observe at home

- lower threshold if young <1-2 yrs since skull fx more common and more risk for abuse

- image if significant scalp findings

- 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

- call neurosurg if intracranial inj, skull fx depressed or widely diastatic

See also

Peds: Head CT (Peds)

Source

Adapted from Pani