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Imaging of Abusive Trauma

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Abstract

“Shaken baby syndrome” is a term often used by the physicians and public to describe abusive trauma inflicted on infants and young children. Advances in the understanding of the mechanisms and the associated clinical spectrum of injury has lead us to modify our terminology and address it as “abusive trauma” (AT). Pediatric abusive head trauma is defined as an injury to the skull or intracranial contents of an infant or a young child (< 5 y age) due to inflicted blunt impact and/or violent shaking. This chapter focuses on the imaging aspects of childhood abusive trauma along with a brief description of the mechanism and pathophysiology of abusive injury. The diagnosis of AT is not always obvious, and abusive injuries in many infants may remain unrecognized. Pediatricians should be cognizant of AT since pediatricians play a crucial role in the diagnosis, management and prevention of AT.

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References

  1. Tardieu A Etude medico-legale sur les services et mauvais traitments exerces sue des enfants. Ann Hyg Publ Med Leg. 1860;13:361–98.

    Google Scholar 

  2. Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK. The battered-child syndrome. J Am Med Assoc. 1962;181:17–24.

    Article  CAS  Google Scholar 

  3. Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics. 1974;54:396–403.

    PubMed  CAS  Google Scholar 

  4. Christian CW, Block R; Committee on Child Abuse and Neglect; American Academy of Pediatrics. Abusive head trauma in infants and children. Pediatrics. 2009;123:1409–11.

    Article  PubMed  Google Scholar 

  5. Adamsbaum C, Barr M. Imaging in abusive head trauma: an in-depth look at current issues. Pediatr Radiol. 2014;44:S535–6.

    Article  PubMed  Google Scholar 

  6. Frasier LD, Kelly P, Al-Eissa M, Otterman GJ. International issues in abusive head trauma. Pediatr Radiol. 2014;44:S647–53.

    Article  PubMed  Google Scholar 

  7. Parks SE, Kegler SR, Annest JL, Mercy JA. Characteristics of fatal abusive head trauma among children in the USA: 2003-2007: an application of the CDC operational case definition to national vital statistics data. Inj Prev. 2012;18:193–9.

    Article  PubMed  Google Scholar 

  8. Parks S, Sugerman D, Xu L, Coronado V. Characteristics of non-fatal abusive head trauma among children in the USA, 2003–2008: application of the CDC operational case definition to national hospital inpatient data. Inj Prev. 2012;18:392–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Christian CW; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015;135:e1337–54.

  10. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child maltreatment. Available at: www.acf.hhs.gov/sites/default/files/cb/cm2012.pdf (2012). Accessed 6 May 2015.

  11. Nadarasa J, Deck C, Meyer F, Willinger R, Raul JS. Update on injury mechanisms in abusive head trauma–shaken baby syndrome. Pediatr Radiol. 2014;44:S565–70.

    Article  PubMed  Google Scholar 

  12. Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J. 1971;2:430–1.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Caffey J. On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child. 1972;124:161–9.

    Article  PubMed  CAS  Google Scholar 

  14. Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg. 1987;66:409–15.

    Article  PubMed  CAS  Google Scholar 

  15. Binenbaum G, Forbes BJ. The eye in child abuse: key points on retinal hemorrhages and abusive head trauma. Pediatr Radiol. 2014;44:S571–7.

    Article  PubMed  Google Scholar 

  16. Sheybani EF, Gonzalez-Araiza G, Kousari YM, Hulett RL, Menias CO. Pediatric nonaccidental abdominal trauma: what the radiologist should know. Radiographics. 2014;34:139–53.

    Article  PubMed  Google Scholar 

  17. Sato Y, Yuh WT, Smith WL, Alexander RC, Kao SC, Ellerbroek CJ. Head injury in child abuse: evaluation with MR imaging. Radiology. 1989;173:653–7.

    Article  PubMed  CAS  Google Scholar 

  18. Vazquez E, Delgado I, Sánchez-Montañez A, Fábrega A, Cano P, Martín N. Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging? Pediatr Radiol. 2014;44:S589–603.

    Article  PubMed  Google Scholar 

  19. Maguire SA, Kemp AM, Lumb RC, Farewell DM. Estimating the probability of abusive head trauma: a pooled analysis. Pediatrics. 2011;128:e550–64.

    PubMed  Google Scholar 

  20. Vezina G. Assessment of the nature and age of subdural collections in nonaccidental head injury with CT and MRI. Pediatr Radiol. 2009;39:586–90.

    Article  PubMed  Google Scholar 

  21. Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain. 2001;124:1290–8.

    PubMed  CAS  Google Scholar 

  22. Sieswerda-Hoogendoorn T, Boos S, Spivack B, Bilo RA, van Rijn RR. Abusive head trauma part II: radiological aspects. Eur J Pediatr. 2012;171:617–23.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sieswerda-Hoogendoorn T, Boos S, Spivack B, Bilo RA, van Rijn RR. Educational paper: abusive head trauma part I. Clinical aspects. Eur J Pediatr. 2012;171:415–23.

    Article  PubMed  Google Scholar 

  24. Hsieh KL, Zimmerman RA, Kao HW, Chen CY. Revisiting neuroimaging of abusive head trauma in infants and young children. AJR Am J Roentgenol. 2015;204:944–52.

    Article  PubMed  Google Scholar 

  25. Zimmerman RA, Bilaniuk LT, Farina L. Non-accidental brain trauma in infants: diffusion imaging, contributions to understanding the injury process. J Neuroradiol. 2007;34:109–14.

    Article  PubMed  CAS  Google Scholar 

  26. Jaspan T, Griffiths PD, McConachie NS, Punt JA. Neuroimaging for non-accidental head injury in childhood: a proposed protocol. Clin Radiol. 2003;58:44–53.

    Article  PubMed  CAS  Google Scholar 

  27. Gilles EE, Nelson MD Jr. Cerebral complications of nonaccidental head injury in childhood. Pediatr Neurol. 1998;19:119–28.

  28. Kemp AM, Dunstan F, Harrison S, et al. Patterns of skeletal fractures in child abuse: systematic review. BMJ. 2008;337:a1518.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Altinok D, Saleem S, Zhang Z, Markman L, Smith W. MR imaging findings of retinal hemorrhage in a case of nonaccidental trauma. Pediatr Radiol. 2009;39:290–2.

    Article  PubMed  Google Scholar 

  30. Zuccoli G, Panigrahy A, Haldipur A, et al. Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma. Neuroradiology. 2013;55:889–93.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kemp A, Cowley L, Maguire S. Spinal injuries in abusive head trauma: patterns and recommendations. Pediatr Radiol. 2014;44:S604–12.

    Article  PubMed  Google Scholar 

  32. Kadom N, Khademian Z, Vezina G, Shalaby-Rana E, Rice A, Hinds T. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. Pediatr Radiol. 2014;44:839–48.

    Article  PubMed  Google Scholar 

  33. Silvera VM, Danehy AR, Newton AW, et al. Retroclival collections associated with abusive head trauma in children. Pediatr Radiol. 2014;44:S621–31.

    Article  PubMed  Google Scholar 

  34. Barber I, Kleinman PK. Imaging of skeletal injuries associated with abusive head trauma. Pediatr Radiol. 2014;44:S613–20.

    Article  PubMed  Google Scholar 

  35. (ACR), A.C.o.R. ACR practice guidelines for skeletal surveys in children. Available at: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/pediatric/skeletal_surveys.aspx (2009). Amended 2014 (Resolution 39). Accessed 5 June 2015.

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Acknowledgments

Special thanks to Cindy Christian, M.D., The Children’s Hospital of Philadelphia Endowed Chair in Prevention of Child Abuse and Neglect, for expert guidance and providing statistical data. The author thanks Valerie Vigna, for secretarial assistance and Jessica Yim for assistance with illustrations and tables.

Guarantor

Dr. Maohar Shroff, Radiologist-in-Chief, Hospital for Sick Children, Toronto, Canada will act as guarantor for the paper.

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  1. Department of Radiology-Neuroradiology Division, Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA

    Karuna Shekdar

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  1. Karuna Shekdar
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Correspondence to Karuna Shekdar.

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Shekdar, K. Imaging of Abusive Trauma. Indian J Pediatr 83, 578–588 (2016). https://doi.org/10.1007/s12098-016-2043-0

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  • DOI: https://doi.org/10.1007/s12098-016-2043-0

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