Spinal Subdural Hemorrhage Linked to Abusive Head Trauma

High incidence in children with abusive head trauma who underwent thoracolumbar imaging

WEDNESDAY, Nov. 9 (HealthDay News) -- The incidence of spinal subdural hemorrhage is high among children with abusive head trauma, and rare among those with accidental trauma, according to a study published online Nov. 8 in Radiology.

Arabinda Kumar Choudhary, M.D., M.R.C.P., from the Penn State University College of Medicine in Hershey, and colleagues investigated abusive versus accidental head trauma in children (aged 0 to 2 years), and compared the relative incidence, distribution, and radiologic characteristics of spinal subdural hemorrhage after head trauma. The analysis included 252 children treated for abusive head trauma between 1997 and 2009, and 70 children treated for well-documented accidental trauma between 2003 and 2010. Reviews included all clinical data and cross-sectional imaging results collected from both the groups. The statistical significance of the proportion of spinal canal subdural hemorrhage was assessed in abusive versus accidental trauma groups.

The investigators found that 26.5 percent of the children in the abusive trauma group had evaluable spinal imaging results. Thoracolumbar imaging was performed on 56 percent of those patients, and thoracolumbar subdural hemorrhage was observed in 63 percent of those imaged. The children underwent spinal imaging 0.3 to 141 hours after injury (mean 23 hours), with 97 percent of imaging performed within 52 hours of injury. Only one of the 70 children in the accidental trauma group presented with spinal subdural hemorrhage, and this child had a displaced occipital fracture. The difference of spinal subdural hemorrhage incidences between the abusive versus accidental trauma groups was statistically significant.

"We found in our study a high incidence of spinal subdural hemorrhage in abusive head trauma in cases where the thoracolumbar spine was imaged," the authors write.

One of the study authors received compensation for presentations on abusive head trauma and pediatric neurosurgery, and for expert testimony in child abuse court cases.

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