An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging Findings.

BACKGROUND AND PURPOSE

Abusive head trauma is the leading cause of morbidity and mortality in young children. Radiology provides valuable information for this challenging diagnosis, but no single neuroimaging finding is independently diagnostic of abusive head trauma. Our purposes were to describe the prevalence of brain and spine neuroimaging findings and to analyze the association of neuroimaging findings with clinical factors to determine which neuroimaging findings may be used as prognostic indicators.

MATERIALS AND METHODS

Children with a confirmed abusive head trauma diagnosis between January 2018 to February 2021 were included in this single-center retrospective study. Patient demographics, survival, Glasgow Coma Scale score on admission, length of hospital stay, and intensive care unit stay were examined. Brain neuroimaging findings were categorized as classic and nonclassic findings. Spine MRIs were also assessed for spinal ligamentous injury, compression fracture, and hemorrhage. The χ test or the Wilcoxon rank-sum test was used for the analysis.

RESULTS

One hundred two children (male/female ratio: 75:27; average age, 9.49; range, 0.27-53.8 months) were included. Subdural hematoma was the most common (83.3%) classic neuroimaging finding. Bridging vein thrombosis was the most common (30.4%) nonclassic neuroimaging finding. Spinal ligamentous injury was seen in 23/49 patients. Hypoxic-ischemic injury was significantly higher in deceased children (= .0001). The Glasgow Coma Scale score was lower if hypoxic-ischemic injury (< .0001) or spinal ligamentous injury were present (= .017). The length of hospital stay was longer if intraventricular hemorrhage (= .04), diffuse axonal injury (= .017), hypoxic-ischemic injury (= .001), or arterial stroke (= .0003) was present. The intensive care unit stay was longer if intraventricular hemorrhage (= .02), diffuse axonal injury (= .01), hypoxic-ischemic injury (< .0001), or spinal ligamentous injury (= .03) was present.

CONCLUSIONS

Our results may suggest that a combination of intraventricular hemorrhage, diffuse axonal injury, hypoxic-ischemic injury, arterial stroke, and/or spinal ligamentous injury on neuroimaging at presentation may be used as potential poor prognostic indicators in children with abusive head trauma.