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Intracranial injuries on computed tomography head scans in infants investigated for suspected physical abuse: a retrospective review
  1. Helen Daley1,
  2. Hilary Smith1,
  3. Samantha McEvedy2,
  4. Rachel King3,
  5. Edward Andrews4,
  6. Faye Hawkins5,
  7. Nicole Guppy4,
  8. Todorka Kiryazova6,
  9. Rebecca Macleod3,
  10. Emma Blake6,
  11. Rachael Harrison7
  1. 1Department of Community Paediatrics, Solent NHS Trust, Fareham, UK
  2. 2The Academy of Research and Improvement, Solent NHS Trust, Portsmouth, UK
  3. 3Department of Paediatrics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
  4. 4Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, UK
  5. 5Department of Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  6. 6Department of Paediatrics, Isle of Wight NHS Trust, Newport, Isle of Wight, UK
  7. 7Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
  1. Correspondence to Dr Helen Daley, Department of Community Paediatrics, Solent NHS Trust, Fareham PO15 5RQ, UK; helen.daley{at}nhs.net

Abstract

Background UK national guidelines recommend that investigation of infants (aged <12 months) with suspected physical abuse should always include CT head scans. Such imaging carries small but recognised risks from radiation exposure. Studies report a range of yields for occult intracranial injuries in suspected physical abuse.

Aims To report the yield of intracranial injuries on CT head scans carried out for suspected physical abuse in infants, compare yields for those presenting with or without signs of head injury and to describe selected clinical and radiological features.

Methods A retrospective cross-sectional review of case records of infants undergoing skeletal survey for suspected physical abuse in Wessex, England. The main outcome measure was yield of intracranial injuries on CT head scan.

Results In total, n=363 CT head scans were included (n=275 aged <6 months). The overall yield of intracranial injury was 37 (10%). Among 68 infants presenting with neurological signs or skull fractures, yield was 36 (53%) compared with just 1 (0.34%) of 295 without neurological signs or skull fractures. This one intracranial injury was found to be consistent with an accidental fall. Scalp injury was the only additional clinical feature associated with intracranial injury.

Conclusion In suspected physical abuse, CT head scans should be carried out in infants who present with neurological signs, skull fractures or scalp injuries. However, in balancing potential risks and benefits, we question the value of performing a CT head scan in every infant investigated for suspected physical abuse.

  • child abuse
  • neuropathology

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Footnotes

  • Contributors HD, HS and SM made substantial contributions to the conception and design of the work. HD, RK, EA, FH, NG, TK, RM, EB and RH collected the data. HD wrote the first draft of the manuscript. All authors analysed and interpreted the data, and contributed to critical appraisal and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the NHS Health Research Authority, East of England-Cambridgeshire and Hertfordshire Research Ethics Committee (19/EE/0355).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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