Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review

Objectives To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT). Design Systematic review. Setting Literature search of 14 databases, websites, textbooks, conference abstracts and references (1970–Februar...

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Veröffentlicht in:Archives of disease in childhood 2011-12, Vol.96 (12), p.1103-1112
Hauptverfasser: Kemp, A M, Jaspan, T, Griffiths, J, Stoodley, N, Mann, M K, Tempest, V, Maguire, S A
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container_end_page 1112
container_issue 12
container_start_page 1103
container_title Archives of disease in childhood
container_volume 96
creator Kemp, A M
Jaspan, T
Griffiths, J
Stoodley, N
Mann, M K
Tempest, V
Maguire, S A
description Objectives To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT). Design Systematic review. Setting Literature search of 14 databases, websites, textbooks, conference abstracts and references (1970–February 2010). Studies had two independent reviews (three if disputed) and critical appraisal. Patients Primary comparative studies of children
doi_str_mv 10.1136/archdischild-2011-300630
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A systematic review</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><creator>Kemp, A M ; Jaspan, T ; Griffiths, J ; Stoodley, N ; Mann, M K ; Tempest, V ; Maguire, S A</creator><creatorcontrib>Kemp, A M ; Jaspan, T ; Griffiths, J ; Stoodley, N ; Mann, M K ; Tempest, V ; Maguire, S A</creatorcontrib><description>Objectives To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT). Design Systematic review. Setting Literature search of 14 databases, websites, textbooks, conference abstracts and references (1970–February 2010). Studies had two independent reviews (three if disputed) and critical appraisal. Patients Primary comparative studies of children &lt;11 years old hospitalised with AHT and nAHT diagnosed on CT or MRI. Main outcome measures Neuroradiological features that differentiated AHT from nAHT. Results 21 studies of children predominantly &lt;3 years old were analysed. Subdural haemorrhages (SDH) were significantly associated with AHT (OR 8.2, 95% CI 6.1 to 11). Subarachnoid haemorrhages were seen equally in AHT and nAHT and extradural haemorrhages (EDH) were significantly associated with nAHT (OR for AHT 0.1, 95% CI 0.07 to 0.18). Multiple (OR 6, 95% CI 2.5 to 14.4), interhemispheric (OR 7.9, 95% CI 4.7 to 13), convexity (OR 4.9, 95% CI 1.3 to 19.4) and posterior fossa haemorrhages (OR 2.5, 95% CI 1 to 6) were associated with AHT. Hypoxic-ischaemic injury (HII) (OR 3.7, 95% CI 1.4 to 10) and cerebral oedema (OR 2.2, 95% CI 1.0 to 4.5) were significantly associated with AHT, while focal parenchymal injury was not a discriminatory feature. SDH of low attenuation were more common in AHT than in nAHT. Conclusion Multiple SDH over the convexity, interhemispheric haemorrhages, posterior fossa SDH, HII and cerebral oedema are significantly associated with AHT and should be considered together with clinical features when identifying the condition.</description><identifier>ISSN: 0003-9888</identifier><identifier>EISSN: 1468-2044</identifier><identifier>DOI: 10.1136/archdischild-2011-300630</identifier><identifier>PMID: 21965812</identifier><identifier>CODEN: ADCHAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher><subject>Biological and medical sciences ; Brain Edema - diagnosis ; Brain Edema - etiology ; Child ; Child Abuse ; Child abuse &amp; neglect ; Child Abuse - diagnosis ; Child Neglect ; Child Safety ; Child, Preschool ; Children &amp; youth ; Comparative Analysis ; Comparative studies ; Craniocerebral Trauma - etiology ; Diagnosis, Differential ; Diagnostic Tests ; Edema ; Evidence ; Evidence-Based Medicine - methods ; General aspects ; Head injuries ; Hemorrhage ; Humans ; Hypoxia ; Infant ; Infant, Newborn ; Information Seeking ; Injuries of the nervous system and the skull. Diseases due to physical agents ; Intracranial Hemorrhages - diagnosis ; Intracranial Hemorrhages - etiology ; Ischemia ; Magnetic Resonance Imaging ; Medical imaging ; Medical sciences ; Meta Analysis ; Miscellaneous ; Neuroimaging ; Neurology ; Ophthalmology ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Search Strategies ; Systematic review ; Tomography, X-Ray Computed ; Trauma ; Traumas. Diseases due to physical agents ; Young Children</subject><ispartof>Archives of disease in childhood, 2011-12, Vol.96 (12), p.1103-1112</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2011 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b520t-518b1fe3acd941c363332074f556f29b44aa7d59449bf646177f969540f74a3a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://adc.bmj.com/content/96/12/1103.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://adc.bmj.com/content/96/12/1103.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77569,77600</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=24770719$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21965812$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kemp, A M</creatorcontrib><creatorcontrib>Jaspan, T</creatorcontrib><creatorcontrib>Griffiths, J</creatorcontrib><creatorcontrib>Stoodley, N</creatorcontrib><creatorcontrib>Mann, M K</creatorcontrib><creatorcontrib>Tempest, V</creatorcontrib><creatorcontrib>Maguire, S A</creatorcontrib><title>Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review</title><title>Archives of disease in childhood</title><addtitle>Arch Dis Child</addtitle><description>Objectives To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT). Design Systematic review. Setting Literature search of 14 databases, websites, textbooks, conference abstracts and references (1970–February 2010). Studies had two independent reviews (three if disputed) and critical appraisal. Patients Primary comparative studies of children &lt;11 years old hospitalised with AHT and nAHT diagnosed on CT or MRI. Main outcome measures Neuroradiological features that differentiated AHT from nAHT. Results 21 studies of children predominantly &lt;3 years old were analysed. Subdural haemorrhages (SDH) were significantly associated with AHT (OR 8.2, 95% CI 6.1 to 11). Subarachnoid haemorrhages were seen equally in AHT and nAHT and extradural haemorrhages (EDH) were significantly associated with nAHT (OR for AHT 0.1, 95% CI 0.07 to 0.18). Multiple (OR 6, 95% CI 2.5 to 14.4), interhemispheric (OR 7.9, 95% CI 4.7 to 13), convexity (OR 4.9, 95% CI 1.3 to 19.4) and posterior fossa haemorrhages (OR 2.5, 95% CI 1 to 6) were associated with AHT. Hypoxic-ischaemic injury (HII) (OR 3.7, 95% CI 1.4 to 10) and cerebral oedema (OR 2.2, 95% CI 1.0 to 4.5) were significantly associated with AHT, while focal parenchymal injury was not a discriminatory feature. SDH of low attenuation were more common in AHT than in nAHT. Conclusion Multiple SDH over the convexity, interhemispheric haemorrhages, posterior fossa SDH, HII and cerebral oedema are significantly associated with AHT and should be considered together with clinical features when identifying the condition.</description><subject>Biological and medical sciences</subject><subject>Brain Edema - diagnosis</subject><subject>Brain Edema - etiology</subject><subject>Child</subject><subject>Child Abuse</subject><subject>Child abuse &amp; neglect</subject><subject>Child Abuse - diagnosis</subject><subject>Child Neglect</subject><subject>Child Safety</subject><subject>Child, Preschool</subject><subject>Children &amp; youth</subject><subject>Comparative Analysis</subject><subject>Comparative studies</subject><subject>Craniocerebral Trauma - etiology</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic Tests</subject><subject>Edema</subject><subject>Evidence</subject><subject>Evidence-Based Medicine - methods</subject><subject>General aspects</subject><subject>Head injuries</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Hypoxia</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Information Seeking</subject><subject>Injuries of the nervous system and the skull. Diseases due to physical agents</subject><subject>Intracranial Hemorrhages - diagnosis</subject><subject>Intracranial Hemorrhages - etiology</subject><subject>Ischemia</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Meta Analysis</subject><subject>Miscellaneous</subject><subject>Neuroimaging</subject><subject>Neurology</subject><subject>Ophthalmology</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Search Strategies</subject><subject>Systematic review</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma</subject><subject>Traumas. 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Diseases due to physical agents</topic><topic>Intracranial Hemorrhages - diagnosis</topic><topic>Intracranial Hemorrhages - etiology</topic><topic>Ischemia</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Meta Analysis</topic><topic>Miscellaneous</topic><topic>Neuroimaging</topic><topic>Neurology</topic><topic>Ophthalmology</topic><topic>Prevention and actions</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Search Strategies</topic><topic>Systematic review</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma</topic><topic>Traumas. 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A systematic review</atitle><jtitle>Archives of disease in childhood</jtitle><addtitle>Arch Dis Child</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>96</volume><issue>12</issue><spage>1103</spage><epage>1112</epage><pages>1103-1112</pages><issn>0003-9888</issn><eissn>1468-2044</eissn><coden>ADCHAK</coden><abstract>Objectives To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT). Design Systematic review. Setting Literature search of 14 databases, websites, textbooks, conference abstracts and references (1970–February 2010). Studies had two independent reviews (three if disputed) and critical appraisal. Patients Primary comparative studies of children &lt;11 years old hospitalised with AHT and nAHT diagnosed on CT or MRI. Main outcome measures Neuroradiological features that differentiated AHT from nAHT. Results 21 studies of children predominantly &lt;3 years old were analysed. Subdural haemorrhages (SDH) were significantly associated with AHT (OR 8.2, 95% CI 6.1 to 11). Subarachnoid haemorrhages were seen equally in AHT and nAHT and extradural haemorrhages (EDH) were significantly associated with nAHT (OR for AHT 0.1, 95% CI 0.07 to 0.18). Multiple (OR 6, 95% CI 2.5 to 14.4), interhemispheric (OR 7.9, 95% CI 4.7 to 13), convexity (OR 4.9, 95% CI 1.3 to 19.4) and posterior fossa haemorrhages (OR 2.5, 95% CI 1 to 6) were associated with AHT. Hypoxic-ischaemic injury (HII) (OR 3.7, 95% CI 1.4 to 10) and cerebral oedema (OR 2.2, 95% CI 1.0 to 4.5) were significantly associated with AHT, while focal parenchymal injury was not a discriminatory feature. SDH of low attenuation were more common in AHT than in nAHT. Conclusion Multiple SDH over the convexity, interhemispheric haemorrhages, posterior fossa SDH, HII and cerebral oedema are significantly associated with AHT and should be considered together with clinical features when identifying the condition.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</pub><pmid>21965812</pmid><doi>10.1136/archdischild-2011-300630</doi><tpages>10</tpages></addata></record>
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subjects Biological and medical sciences
Brain Edema - diagnosis
Brain Edema - etiology
Child
Child Abuse
Child abuse & neglect
Child Abuse - diagnosis
Child Neglect
Child Safety
Child, Preschool
Children & youth
Comparative Analysis
Comparative studies
Craniocerebral Trauma - etiology
Diagnosis, Differential
Diagnostic Tests
Edema
Evidence
Evidence-Based Medicine - methods
General aspects
Head injuries
Hemorrhage
Humans
Hypoxia
Infant
Infant, Newborn
Information Seeking
Injuries of the nervous system and the skull. Diseases due to physical agents
Intracranial Hemorrhages - diagnosis
Intracranial Hemorrhages - etiology
Ischemia
Magnetic Resonance Imaging
Medical imaging
Medical sciences
Meta Analysis
Miscellaneous
Neuroimaging
Neurology
Ophthalmology
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Search Strategies
Systematic review
Tomography, X-Ray Computed
Trauma
Traumas. Diseases due to physical agents
Young Children
title Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review
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