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Accuracy of the history of injury obtained from the caregiver in infantile head trauma

      Abstract

      Objective

      We investigated the accuracy of parental reports of infant trauma history.

      Methods

      We retrospectively reviewed 166 infants from 3 tertiary institutions in Japan that had suffered a traumatic intracranial hemorrhage between 2002 and 2013. The infants were classified into 3 groups based on the parents' report of the mechanism of injury: the low-risk group consisted of injuries sustained from falling off a height below 3 ft. (n = 84); the middle-to-high-risk group comprised other mechanisms of injury (n = 54); and the unknown-risk group consisted of unknown mechanisms of injury (n = 28). The severity, neurological outcomes, clinical features, and evaluation for abuse were compared among these 3 groups.

      Results

      Infants in the low-risk group had a higher severity, a worse neurological outcome, and a higher percentage of household injuries, retinal hemorrhage, subdural hematoma, and subdural hematoma suggestive of abusive head trauma (AHT) than those in the middle-to-high-risk group (P < .05). Infants in the unknown-risk group had the highest severity and the worst neurological outcomes, and a higher rate of features suggestive of AHT (P < .05).

      Conclusions

      The accuracy of the history obtained from the caregivers of infants may be low in severe infantile head trauma. Therefore, medical professionals should treat the mechanism of injury obtained from caregivers as secondary information and investigate for possible AHT in cases with inconsistencies between the history that was taken and the severity of the injury observed.
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      References

        • Langlois JA
        • Rutland-Brown W
        • Thomas KE
        The incidence of traumatic brain injury among children in the United States: differences by race.
        J Head Trauma Rehabil. 2005; 20: 229-238
        • Keenan HT
        • Runyan DK
        • Marshall SW
        • Nocera MA
        • Merten DF
        • Sinal SH
        A population-based study of inflicted traumatic brain injury in young children.
        JAMA. 2003; 290: 621-626
        • Fujiwara T
        • Okuyama M
        • Miyasaka M
        Characteristics that distinguish abusive from nonabusive head trauma among young children who underwent head computed tomography in Japan.
        Pediatrics. 2008; 122: e841-e847
        • Williams RA
        Injuries in infants and small children resulting from witnessed and corroborated free falls.
        J Trauma. 1991; 31: 1350-1352
        • Chadwick DL
        • Bertocci G
        • Castillo E
        • et al.
        Annual risk of death resulting from short falls among young children: less than 1 in 1million.
        Pediatrics. 2008; 12: 1213-1224
        • Fujiwara T
        • Nagase H
        • Okumura M
        • Hoshino T
        • Aoki K
        • Nagashima T
        • et al.
        Validity of caregivers' reports on head trauma due to falls in young children aged less than 2 years.
        Clin Med Insights Pediatr. 2010; 4: 11-18
        • Helfer RE
        • Solvis TL
        • Black M
        Injuries resulting when small children fall out of bed.
        Pediatrics. 1977; 60: 533-535
        • Nimityongskul P
        • Anderson LD
        The likelihood of injuries when children fall out of bed.
        J Pediatr Orthop. 1987; 7: 184-186
        • Lyons TJ
        • Oates RK
        Falling out of bed: a relatively benign occurrence.
        Pediatrics. 1993; 92: 125-127
        • Levene S
        • Bonfield G
        Accidents on hospital wards.
        Arch Dis Child. 1991; 66: 1047-1049
        • Aoki N
        • Masuzawa H
        Infantile acute subdural hematoma. Clinical analysis of 26 cases.
        J Neurosurg. 1984; 61: 273-280
        • Aoki N
        • Masuzawa H
        Subdural hematomas in abused children: report six cases from Japan.
        Neurosurgery. 1986; 18: 475-477
        • Fung EL
        • Sung RY
        • Nelson EA
        • Poon WS
        Unexplained subdural hematoma in young children: is it always child abuse?.
        Pediatr Int. 2002; 44: 37-42
        • Kelvin JD
        Ophthalmic manifestations of shaken baby syndrome.
        in: Lazorits S. Palusci V.J. The shaken baby syndrome: multidisciplinary approach. Haworth Maltreatment & Trauma Press, Binghamton, New York2001: 137-153
        • Boyd CR
        • Tolson MA
        • Copes WS
        Evaluating trauma care: the TRISS method. Trauma score and the injury severity score.
        J Trauma. 1987; 27: 370-380
        • Fiser DH
        Assessing the outcome of pediatric intensive care.
        J Pediatr. 1992; 121: 68-74
        • Kemp AM
        • Jaspan T
        • Griffiths J
        • Stoodley N
        • Mann MK
        • Tempest V
        • et al.
        Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review.
        Arch Dis Child. 2011; 96: 1103-1112
        • Duhaime AC
        • Alario AJ
        • Lewander WJ
        • Schut L
        • Sutton LN
        • Seidl TS
        • et al.
        Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age.
        Pediatrics. 1992; 90: 179-185
        • Reiber GD
        Fatal falls in childhood. How far must children fall to sustain fatal head injury? Report of cases and review of the literature.
        Am J Forensic Med Pathol. 1993; 14: 201-207
        • Hettler J
        • Greenes DS
        Can the initial history predict whether a child with a head injury has been abused?.
        Pediatrics. 2003; 111: 602-607
        • Piteau SJ
        • Ward MG
        • Barrowman NJ
        • Plint AC
        Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review.
        Pediatrics. 2012; 130: 315-323
        • King WJ
        • MacKay M
        • Sirnick K
        Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases.
        CMAJ. 2003; 168: 155-159