We present data that raises questions about the need for routine CT head in infants aged 0–12 months old with suspected physical abuse. We performed an audit of our compliance with the Joint RCPCH and RCR guidelines 2008, which recommend that infants under the age of 12 months with suspected physical abuse undergo a CT head as part of their skeletal survey to exclude occult injury.
Methods We performed a retrospective analysis of infants aged 1 year or less who were investigated for suspected physical abuse with a skeletal survey. We reviewed whether CT head was performed in every case, and from case notes whether their presentation was symptomatic of Non-Accidental Head injury. The period of study was December 2011 – January 2015. Cases of sudden unexpected death in infancy were excluded, as were infants who had skeletal surveys for other clinical reasons.
Results We reviewed 111 skeletal survey reports, which revealed 16 occult skeletal injuries (14.4%). 100/111 patients underwent a CT head, achieving 90.1% concordance with the national guideline. 58/100 CT scans were normal, all infants were asymptomatic and had routine CT scans. 42/100 were abnormal, 39/42 were symptomatic infants, scans undertaken urgently for presenting features of abusive head trauma (acute encephalopathy 23, significant impact trauma 14, suspected raised ICP 2). 3/42 infants had intracranial abnormalities of uncertain significance related to their underlying condition and not to abusive head trauma. CT Head did not reveal any occult non-accidental head injury in the asymptomatic cohort.
Conclusion Only 3/100 CT showed occult abnormality which were not felt to be suggestive of abusive head trauma. Although the total number of infants is low, the yield for occult head trauma in this retrospective case series was negligible, less than that previously reported for infants without neurological concerns at presentation. We suggest that a larger, prospective study is needed to clearly establish the role of routine CT head in excluding occult injuries in the potentially abused infant. The yield from skeletal survey was 14.4% is in line with other published studies, suggesting that this investigation has a role in medical assessment of suspected physical abuse.
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