Abusive head trauma in children : the extent and clinical characteristics

Abstract EN

Background : Abusive head trauma (AHT) is the leading cause of death in child abuse.

Knowledge about AHT in Bahrain is lacking.

The objectives are to identify the extent of AHT in Bahrain, victims’ characteristics and the clinical features.

Setting : Child Protection Unit, Salmaniya Medical Complex.

Design : Retrospective review.

Method : Abusive head traumas were evaluated between 2000 and 2009.

Victims’ characteristics, patterns of presentation and result of investigations were recorded.

SPSS version 17 for Windows was used for data management and statistical analyses.

Result: Twenty-three patients with the diagnosis of AHT were identified.

In 18 (78 %) the age is one year or below; 16 (70%) were males.

No plausible explanation for the head injuries was given in 16 (70 %) patients.

Vomiting was seen in 13 (56.5 %), seizures in 13 (56.5 %), altered state of consciousness in 12 (52 %), irritability in 12 (52 %), difficulty of breathing in 9 (39 %), coma in 8 (35 %), apnea in 4 (17 %), chocking episodes in 3 (13 %) and two were dead on arrival.

The total death after AHT was four (17 %).

Subdural hemorrhage was identified in 19 (83 %), cerebral hemorrhage in 17 (74 %) and retinal hemorrhage in 13 (56.5%).

Evidence of blunt impact were bruises in 13 (56.5 %), skull fractures in 9 (39 %), localized scalp swelling in 5 (22 %) and subgaleal hematoma in 2 (9 %).

Conclusion : AHT is associated with a high morbidity and mortality.

The presenting symptoms of AHT are non-specific ; therefore, maintaining a high index of suspicion is paramount.

All children presenting with a life-threatening event or head injuries without a plausible explanation should undergo a multidisciplinary assessment for AHT.

A prospective national study is required.