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Head computed tomography in suspected physical abuse: time to rethink?
  1. Kathryn Glenn1,
  2. Elizabeth Nickerson1,
  3. C Verity Bennett2,
  4. Aideen Naughton3,
  5. Laura Elizabeth Cowley4,
  6. Emily Morris1,
  7. Una Murtagh1,
  8. Katina Kontos1,
  9. Alison Mary Kemp5
  1. 1Department of Community Child Health, Cardiff and Vale University Health Board, Cardiff, UK
  2. 2Division of Population Medicine, Cardiff University, Cardiff, UK
  3. 3Paediatrics, Public Health Wales, Cardiff, UK
  4. 4Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
  5. 5Division of Population Medicine, Cardiff University College of Biomedical and Life Sciences, Cardiff, UK
  1. Correspondence to Dr Kathryn Glenn, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; Kathryn.Glenn{at}wales.nhs.uk

Abstract

Background National guidance recommends CT-head for all children <1 year old with suspected physical abuse, and to be considered for those <2 years old to exclude abusive head trauma.

Objectives To investigate whether this guidance is followed, and the associations between clinical presentation and CT findings, to determine whether guidance could be refined.

Materials and methods A retrospective case note review of all children <2 years old who underwent medical assessment for suspected abuse (2009–2017). Outcome measures were frequency of CT-head, and diagnostic yield of intracranial injury, skull fracture or both.

Results CT-head was undertaken in 60.3% (152/252) of children <12 months old and 7.8% (13/167) of those aged 12–24 months. The diagnostic yield in children who had a CT-head was 27.1% in children <6 months old, 14.3% in those 6–12 months old (p=0.07) and 42.6% (6/13) in those 12–24 months old. For those with head swelling or neurological impairment, it was 84.2% (32/38). In children <12 months old without these clinical features, the estimated prevalence of occult head injury was 6.1% (7/115). The strongest predictors of an abnormal CT-head were swelling to the head (OR 46.7), neurological impairment (OR 20.6) and a low haemoglobin (OR 11.8).

Conclusion All children <2 years of age with suspected physical abuse and neurological impairment or head swelling should undergo CT-head. Where the technical skills and the requisite expertise to interpret MRI exist, an MRI scan may be the optimal first-line neuroimaging investigation in infants who are neurologically stable with injuries unrelated to the head to minimise cranial radiation exposure.

  • child abuse
  • technology
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Footnotes

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  • Contributors AMK conceptualised the study with valuable input from AN and KK. KG, EN, AN, LEC, KK and AMK contributed to the design of the study. KG, EN, EM and UM identified cases for inclusion and extracted the data. CVB and LEC conducted the statistical analysis. KG and AMK drafted the manuscript. CVB drafted the ‘analysis’ and ‘logistic regression’ results sections of the manuscript. KG, EN, CVB, AN, LEC, KK and AMK made substantial contributions to the interpretation and discussion of findings and critically revised the manuscript for important intellectual content. All authors read and approved the final 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 from the NHS Wales Research Ethics Committee 3 (Wales REC 3) was granted on 28 July 2017 (approval number: 16/WA/0003), together with the Confidentiality Advisory Group (CAG) (reference 16/CAG/0022) granted on 17 August 2017.

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

  • Data availability statement Data are available upon reasonable request. Data are available on reasonable request from the corresponding author.

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