Types of injury in children referred with skull fracture and/or intracranial injury whose injuries were diagnosed as accidental or abusive head trauma (AHT), by age
| All accidental and AHT | Under 2 years old | Over 2 years old | ||||||
|---|---|---|---|---|---|---|---|---|
| Accidental | AHT | Accidental | AHT | |||||
| N | N (%) | N (%) | OR (95% CI)† | N (%) | N (%) | OR (95% CI)† | ||
| All | 302 | 75 (29) | 180 (71) | 21 (45) | 26 (55) | |||
| Any head impact | Yes | 201 | 66 (41) | 96 (59) | 0.2 (0.06 to 0.3)** | 15 (38) | 24 (62) | 4.8 (0.7 to 52.8) |
| No | 9 (10) | 84 (90) | 6 (75) | 2 (25) | ||||
| Skull fracture | Yes | 147 | 62 (52) | 57 (48) | 0.1 (0.05 to 0.2)** | 15 (54) | 13 (46) | 0.4 (0.1 to 1.6) |
| No | 13 (10) | 123 (90) | 6 (32) | 13 (68) | ||||
| Intracranial injury | Yes | 246 | 38 (18) | 170 (82) | 16.6 (7.2 to 40.1)** | 15 (39) | 23 (61) | 3.1 (0.5 to 21.4) |
| No | 37 (79) | 10 (21) | 6 (67) | 3 (33) | ||||
| EDH | Yes | 20 | 8 (73) | 3 (27) | 0.1 (0.02 to 0.6)* | 6 (67) | 3 (33) | 0.3 (0.05 to 1.9) |
| No | 67 (27) | 177 (73) | 15 (39) | 23 (61) | ||||
| SDH | Yes | 203 | 19 (11) | 160 (89) | 23.6 (11.1 to 50.4)** | 8 (33) | 16 (67) | 2.6 (0.7 to 10.0) |
| No | 56 (74) | 20 (26) | 13 (57) | 10 (43) | ||||
| SAH | Yes | 51 | 10 (22) | 35 (78) | 1.6 (0.7 to 3.8) | 2 (33) | 4 (67) | 1.7 (0.2 to 20.9) |
| No | 65 (31) | 145 (69) | 19 (46) | 22 (54) | ||||
| Contusion | Yes | 65 | 11 (22) | 40 (78) | 1.7 (0.8 to 3.8) | 3 (21) | 11 (79) | 4.4 (0.9 to 28.1) |
| No | 64 (31) | 140 (69) | 18 (55) | 15 (45) | ||||
| HII‡ | Yes | 46 | 1 (3) | 38 (97) | 19.8 (3.2 to 813)** | 2 (29) | 5 (71) | 2.3 (0.3 to 26.0) |
| No | 74 (34) | 142 (66) | 19 (48) | 21 (53) | ||||
| GHII§ | Yes | 12 | 0 (0) | 10 (100) | ∝ (1.0 to ∝)* | 0 (0) | 2 (100) | ∝ (0.2 to ∝) |
| No | 75 (31) | 170 (69) | 21 (47) | 24 (53) | ||||
| DAI§ | Yes | 10 | 0 (0) | 8 (100) | ∝ (0.7 to ∝) | 0 (0) | 2 (100) | ∝ (0.2 to ∝) |
| No | 75 (30) | 172 (70) | 21 (47) | 24 (53) | ||||
| Oedema | Yes | 24 | 1 (8) | 12 (92) | 5.3 (0.8 to 229) | 2 (18) | 9 (82) | 5.0 (0.8 to 52.5) |
| No | 74 (31) | 168 (69) | 19 (53) | 17 (47) | ||||
| RH¶ | Yes | 132/252 | 3 (3) | 117 (98) | 28.6 (8.5 to 147)** | 3 (25) | 9 (75) | 3.0 (0.5 to 22.9) |
| No | 44 (42) | 60 (58) | 8 (50) | 8 (50) | ||||
| Long bone fracture†† | Yes | 46/288 | 3 (8) | 33 (92) | 4.6 (1.3 to 24.0)* | 1 (10) | 9 (90) | 10.6 (1.2 to 487)* |
| No | 60 (29) | 145 (71) | 20 (54) | 17 (46) | ||||
| Rib fracture†† | Yes | 29/288 | 0 (0) | 27 (100) | ∝ (2.7 to ∝)** | 0 (0) | 2 (100) | ∝ (0.2 to ∝) |
| No | 63 (29) | 151 (71) | 21 (47) | 24 (53) | ||||
| Other fracture†† | Yes | 8/288 | 0 (0) | 4 (100) | ∝ (0.2 to ∝) | 1 (25) | 3 (75) | 2.6 (0.2 to 144) |
| No | 63 (27) | 174 (73) | 20 (47) | 23 (53) | ||||
| Internal injury | Yes | 10 | 0 (0) | 4 (100) | ∝ (0.3 to ∝) | 1 (17) | 5 (83) | 4.8 (0.5 to 236) |
| No | 75 (30) | 176 (70) | 20 (49) | 21 (51) | ||||
| Death | Yes | 30 | 1 (5) | 19 (95) | 8.7 (1.3 to 367)* | 0 (0) | 10 (100) | ∝ (2.7 to ∝)** |
| No | 74 (31) | 161 (69) | 21 (57) | 16 (43) | ||||
*p<0.05, **p<0.001, Fisher's exact test.
†OR with 95% CI, for the odds of AHT versus accidental.
‡Excluding cases later classified as GHII or DAI at autopsy.
§Autopsy diagnosis.
¶The denominator is the 252 children who had dilated fundoscopy.
††The denominator is 241 children under 2 years old who had skeletal survey plus all 47 children over 2 years old.
DAI, diffuse axonal injury; GHII, global hypoxic ischaemic injury; HII, hypoxic ischaemic injury; RH, retinal haemorrhage.