Background The incidence of abusive head injury in children is highest in infancy with nearly 80% of abusive head trauma occurring in children by 2 years. Physical abuse represents a leading cause of traumatic brain injury and has been implicated as an underreported cause of infant mortality. Sensitivity when assessing children for features suggestive of NAI is paramount particularly in the age group less than 2 years.
Current practice All infants below 6 months are admitted following presentation with head injury regardless of the extent or mechanism of injury described.
Aim The purpose of this study was to describe the outcomes of children admitted through one of Ireland’s busiest emergency departments under these guidelines analysing medical, radiological and social outcomes.
Method A retrospective review of patient data using ED Clinical Information systems was performed to establish the number of cases of head injury which led to hospital admission. An extensive chart review, radiological outcome analysis as well as national social worker register review for social outcomes was studied in an effort to ascertain the number of cases of NAI identified.
Results There were 49156 patients seen in ED from 01/06/12 to 31/05/13. 2610 (5.3%) had a diagnosis of head injury; 50 patients (2%) were <6 months. All patients fulfilling our criteria were admitted. 13 patients received direct social worker and/or public health nurse referrals at presentation with the remainder undergoing assessment/referral following admission. 17 patients were imaged detecting 6 skull fractures, 1 haematoma & 1 contusion.
Conclusion At 16% of children having positive radiological findings at 6 months the current guidelines are supported by the imaging outcomes. In addition to the above 3 patients were subject to care orders as a child protection measure, further establishing the need to consider admission for this group who are at-risk of NAI.