AHT diagnoses: The influences of clinical presentation and evidence of impact.
Concomitant suspicious injuries strongly raise odds of abuse diagnosis in subdural hemorrhage
AHT diagnoses: The influences of clinical presentation and evidence of impact.
The frequency of abusive head trauma (abusive head trauma) diagnoses by child abuse pediatricians (child abuse pediatricians), especially regarding external evidence of head impact, has been questioned.
To compare child abuse pediatricians diagnoses in subjects with subdural hemorrhage (subdural hemorrhage) across clinical presentations, including subgroups with and without external evidence of head impact.
Subjects were divided into groups based on clinical presentations: Ill subdural hemorrhage only, Non-ill subdural hemorrhage only, and subdural hemorrhage + concomitant suspicious injuries.
concomitant suspicious injuries make an abuse diagnosis far more likely
Of the 492 study subjects, 386 (78%) were diagnosed with abuse.
Of the 266 subjects without evidence of head impact, 206 (77%) were diagnosed with abuse.
Of the 147 subdural hemorrhage + concomitant suspicious injuries subjects without evidence of head impact, 33% had severe non-retinal injury, such as high specificity and/or multiple fractures or abdominal injury.
In young children with subdural hemorrhage, many of whom are ill and/or have other concerning injuries, child abuse pediatricians often do not diagnose abuse.
Lack of evidence of head impact does not eliminate trauma as a cause of subdural hemorrhage.