Analysis of missed cases of abusive head trauma

Carole Jenny, Kent P. Hymel, Alene Ritzen, Steven E. Reinert, Thomas C. Hay

Research output: Contribution to journalArticle

704 Scopus citations

Abstract

Context: Abusive head trauma (AHT) is a dangerous form of child abuse that can be difficult to diagnose in young children. Objectives: To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis. Design: Retrospective chart review of cases of head trauma presenting between January 1, 1990, and December 31, 1995. Setting: Academic children's hospital. Patients: One hundred seventy-three children younger than 3 years with head injuries caused by abuse. Main Outcome Measures: Characteristics of head-injured children in whom diagnosis of AHT was unrecognized and the consequences of the missed diagnoses. Results: Fifty-four (31.2%) of 173 abused children with head injuries had been seen by physicians after AHT and the diagnosis was not recognized. The mean time to correct diagnosis among these children was 7 days (range, 0-189 days). Abusive head trauma was more likely to be unrecognized in very young white children from intact families and in children without respiratory compromise or seizures. In 7 of the children with unrecognized AHT, misinterpretation of radiological studies contributed to the delay in diagnosis. Fifteen children (27.8%) were reinjured after the missed diagnosis. Twenty-two (40.7%) experienced medical complications related to the missed diagnosis. Four of 5 deaths in the group with unrecognized AHT might have been prevented by earlier recognition of abuse. Conclusion: Although diagnosing head trauma can be difficult in the absence of a history, it is important to consider inflicted head trauma in infants and young children presenting with nonspecific clinical signs.

Original languageEnglish (US)
Pages (from-to)621-626
Number of pages6
JournalJournal of the American Medical Association
Volume281
Issue number7
DOIs
StatePublished - Feb 17 1999

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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