Division of General Pediatrics, Children's Hospital of Philadelphia, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States.
Division of General Pediatrics, Children's Hospital of Philadelphia, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States.
Child Abuse Negl. 2020 May;103:104431. doi: 10.1016/j.chiabu.2020.104431. Epub 2020 Mar 3.
Abusive head injuries in infants may be occult but clinically or forensically important. Data conflict regarding yield of neuroimaging in detecting occult head injuries in infants evaluated for physical abuse, with prior studies identifying yields of 4.3-37.3 %.
(1) To quantify yield of computed tomography or magnetic resonance imaging in identification of occult head injuries in infants with concerns for physical abuse and (2) to evaluate risk factors for occult head injuries.
We conducted a retrospective, stratified, random systematic sample of 529 infants <12 months evaluated for physical abuse at 4 urban children's hospitals in the United States from 2008-2012. Infants with signs or symptoms suggesting head injury or skull fracture on plain radiography (N = 359), and infants without neuroimaging (N = 1) were excluded.
Sampling weights were applied to calculate proportions of infants with occult head injuries. We evaluated for associations between hypothesized risk factors (age <6 months, rib or extremity fracture, facial bruising) and occult head injury using chi-square tests.
Of 169 neurologically normal infants evaluated for abuse, occult head injury was identified in 6.5 % (95 % CI: 2.6, 15.8). Infants <6 months were at higher risk (9.7 %; 95 % CI: 3.6, 23.3) than infants 6-12 months (1.0 %; 95 % CI: 1.3, 20.2). Rib fracture, extremity fracture and facial bruising were not associated with occult head injury.
Occult head injuries were less frequent than previously reported in some studies, but were identified in 1 in 10 infants <6 months. Clinicians should have a low threshold to obtain neuroimaging in young infants with concern for abuse.
婴儿的虐待性头部损伤可能是隐匿性的，但在临床或法医学上很重要。先前的研究表明，在评估身体虐待的婴儿中，神经影像学检测隐匿性头部损伤的阳性率为 4.3-37.3%，而关于其阳性率的数据存在争议。
（1）量化计算机断层扫描或磁共振成像在识别有身体虐待嫌疑的婴儿隐匿性头部损伤中的阳性率；（2）评估隐匿性头部损伤的危险因素。
我们对美国 4 家城市儿童医院在 2008 年至 2012 年间评估的 529 名有身体虐待嫌疑的<12 个月的婴儿进行了回顾性、分层、随机系统抽样。排除有头部影像学异常或颅骨骨折（N=359）和无神经影像学检查（N=1）的婴儿。
应用抽样权重计算隐匿性头部损伤婴儿的比例。我们采用卡方检验评估假设的危险因素（<6 个月、肋骨或四肢骨折、面部瘀伤）与隐匿性头部损伤之间的相关性。
在 169 名神经学正常的虐待评估婴儿中，隐匿性头部损伤的检出率为 6.5%（95%CI：2.6，15.8）。<6 个月的婴儿比 6-12 个月的婴儿（9.7%；95%CI：3.6，23.3）风险更高（1.0%；95%CI：1.3，20.2）。肋骨骨折、四肢骨折和面部瘀伤与隐匿性头部损伤无关。
隐匿性头部损伤的发生率低于某些研究中的先前报告，但在<6 个月的婴儿中每 10 例中就有 1 例。对于有虐待嫌疑的小婴儿，临床医生应将神经影像学检查作为常规检查。
