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Head computed tomography in suspected physical abuse: time to rethink?

Glenn, Kathryn, Nickerson, Elizabeth, Bennett, C. Verity, Naughton, Aideen, Cowley, Laura Elizabeth, Morris, Emily, Murtagh, Una, Kontos, Katina and Kemp, Alison Mary 2020. Head computed tomography in suspected physical abuse: time to rethink? Archives of Disease in Childhood 10.1136/archdischild-2020-320192

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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.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Medicine
Publisher: BMJ Publishing Group
ISSN: 0003-9888
Date of Acceptance: 25 September 2020
Last Modified: 11 Nov 2020 10:30
URI: http://orca.cf.ac.uk/id/eprint/136252

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