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Child protection and radiology joint session

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1A Kemp, 1J Venables, 1D Farewell, 2N Stoodley, 1S Maguire. 1Cardiff University, Cardiff, UK; 2Frenchay Hospital, Bristol, UK

Background: Subdural haemorrhages (SDH) have long been associated with inflicted brain injury, the degree of association of subarachnoid haemorrhage (SAH) and extradural haemorrhage (EDH) is less clear. Expert witnesses are increasingly asked to define the probability of abuse for specific neuroradiological features.

Aim: To conduct a systematic review to define the characteristic neuroradiological features of inflicted brain injury.

Methods: An all-language literature search of 10 databases from 1970 to 2007. Studies were reviewed by two of 30 trained reviewers, using standardised critical appraisal criteria. Inclusion criteria: comparative studies of children less than 18 years of age with confirmed inflicted or non-inflicted brain injury, undergoing neuroimaging. Exclusion criteria: studies of outcome, management or those with inadequate radiological detail. When feasible, positive predictive values (PPV) for SDH, SAH and EDH were calculated.

Results: Of 305 studies reviewed, 12 studies were included. This represents data on 1332 children (909 were under 3 years of age), 537 had inflicted brain injury. Seven studies included children with SDH, whereas five included children with head injuries with associated brain injury. In a child with SDH the estimated PPV for inflicted brain injury was 59% (95% CI 54% to 63%). Three studies confirmed interhemispheric, supratentorial convexity and multiple SDH were significantly more common in inflicted than non-inflicted brain injury. Studies that included all head injuries with co-existing brain injury demonstrated that SAH had a PPV for inflicted brain injury of 43% (95% CI 34% to 52%), whereas EDH only had a PPV of 16% (95% CI 10% to 25%) for inflicted brain injury. In a child aged less than one year, with either SAH or EDH with co-existent skull fracture, but no …

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