Skip to main content
SpringerLink
Log in

Age determination of subdural hematomas: survey among radiologists

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Abusive head trauma is a severe form of child abuse. One important diagnostic finding is the presence of a subdural hematoma. Age determination of subdural hematomas is important to relate radiological findings to the clinical history presented by the caregivers. In court this topic is relevant as dating subdural hematomas can lead to identification of a suspect. The aim of our study is to describe the current practice among radiologists in the Netherlands regarding the age determination of subdural hematomas in children. This is a cross-sectional study, describing the results of an online questionnaire regarding dating subdural hematomas among pediatric and neuro-radiologists in the Netherlands. The questionnaire consisted of sociodemographic questions, theoretical questions and eight pediatric cases in which the participants were asked to date subdural hematomas based on imaging findings. Fifty-one out of 172 radiologists (30 %) filled out the questionnaire. The percentage of participants that reported it was possible to date the subdural hematoma varied between 58 and 90 % for the eight different cases. In four of eight cases (50 %), the age of the subdural hematoma as known from clinical history fell within the range reported by the participants. None of the participants was “very certain” of their age determination. The results demonstrate that there is a considerable practice variation among Dutch radiologists regarding the age determination of subdural hematomas. This implicates that dating of subdural hematomas is not suitable to use in court, as no uniformity among experts exists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Sieswerda-Hoogendoorn T, Boos S, Spivack B, Bilo RA, van Rijn RR (2012) Educational paper: abusive head trauma part I. Clinical aspects. Eur J Pediatr 171:415–423

    Article  PubMed Central  PubMed  Google Scholar 

  2. Green C, Smith JK, Castillo M (1996) Imaging of head trauma in child abuse. Emerg Radiol 3:34–42

    Article  Google Scholar 

  3. Kemp AM, Jaspan T, Griffiths J et al (2011) Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review. Arch Dis Child 96:1103–1112

    Article  CAS  PubMed  Google Scholar 

  4. Vinchon M, Noule N, Tchofo PJ, Soto-Ares G, Fourier C, Dhellemmes P (2004) Imaging of head injuries in infants: temporal correlates and forensic implications for the diagnosis of child abuse. J Neurosurg 101:44–52

    PubMed  Google Scholar 

  5. Bradley WG Jr (1993) MR appearance of hemorrhage in the brain. Radiology 189:15–26

    Article  PubMed  Google Scholar 

  6. Gomori JM, Grossman RI, Goldberg HI, Zimmerman RA, Bilaniuk LT (1985) Intracranial hematomas: imaging by high-field MR. Radiology 157:87–93

    Article  CAS  PubMed  Google Scholar 

  7. Bergstrom M, Ericson K, Levander B, Svendsen P (1977) Computed tomography of cranial subdural and epidural hematomas: variation of attenuation related to time and clinical events such as rebleeding. J Comput Assist Tomogr 1:449–455

    Article  CAS  PubMed  Google Scholar 

  8. Reed D, Robertson WD, Graeb DA, Lapointe JS, Nugent RA, Woodhurst WB (1986) Acute subdural hematomas: atypical CT findings. AJNR Am J Neuroradiol 7:417–421

    CAS  PubMed  Google Scholar 

  9. Scotti G, Terbrugge K, Melancon D, Belanger G (1977) Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg 47:311–315

    Article  CAS  PubMed  Google Scholar 

  10. Bradford R, Choudhary AK, Dias MS (2013) Serial neuroimaging in infants with abusive head trauma: timing abusive injuries. J Neurosurg Pediatr 12:110–119

    Article  PubMed  Google Scholar 

  11. Vezina G (2009) Assessment of the nature and age of subdural collections in nonaccidental head injury with CT and MRI. Pediatr Radiol 39:586–590

    Article  PubMed  Google Scholar 

  12. Lee KS, Bae WK, Bae HG, Doh JW, Yun IG (1997) The computed tomographic attenuation and the age of subdural hematomas. J Korean Med Sci 12:353–359

    CAS  PubMed Central  PubMed  Google Scholar 

  13. Weichert HC, Lohr E, Clar HE, Grote W (1978) Limitations of computerized tomography in diagnosis of subdural hematoma. Neuroradiology 16:469–471

    Article  CAS  PubMed  Google Scholar 

  14. Fobben ES, Grossman RI, Atlas SW et al (1989) MR characteristics of subdural hematomas and hygromas at 1.5 T. AJR Am J Roentgenol 153:589–595

    Article  CAS  PubMed  Google Scholar 

  15. Dias MS, Backstrom J, Falk M, Li V (1998) Serial radiography in the infant shaken impact syndrome. Pediatr Neurosurg 29:77–85

    Article  CAS  PubMed  Google Scholar 

  16. Wells RG, Sty JR (2003) Traumatic low attenuation subdural fluid collections in children younger than 3 years. Arch Pediatr Adolesc Med 157:1005–1010

    Article  PubMed  Google Scholar 

  17. European Society of Neuroradiology. European Charter for education and training in Clinical Neuroradiology (diagnostic and interventional). http://www.esnr.org/en/education-training/charter-standards/. Accessed 1 April 2013

Download references

Acknowledgements

The authors would like to thank all radiologists who were willing to spend their time on answering the questionnaire and thereby participated in this study. Without their efforts, this publication would not have been possible. Furthermore we thank J. van Schuppen for his valuable advice on the development of the questionnaire.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Academic Medical Center Amsterdam, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    F. A. M. Postema

  2. Section of Forensic Paediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, PO Box 24044, 2490 AA, The Hague, The Netherlands

    Tessa Sieswerda-Hoogendoorn & R. R. van Rijn

  3. Department of Radiology, Academic Medical Center/Emma Children’s Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Tessa Sieswerda-Hoogendoorn, C. B. L. M. Majoie & R. R. van Rijn

Authors
  1. F. A. M. Postema
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tessa Sieswerda-Hoogendoorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. B. L. M. Majoie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. R. van Rijn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tessa Sieswerda-Hoogendoorn.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 17.3 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Postema, F.A.M., Sieswerda-Hoogendoorn, T., Majoie, C.B.L.M. et al. Age determination of subdural hematomas: survey among radiologists. Emerg Radiol 21, 349–358 (2014). https://doi.org/10.1007/s10140-014-1196-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-014-1196-2

Keywords

Search

Navigation