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PEDIATRICS Vol. 102 No. 2 August 1998, pp. 300-307

Neuroimaging, Physical, and Developmental Findings After Inflicted and Noninflicted Traumatic Brain Injury in Young Children

Received Jul 22, 1997; accepted Jan 7, 1998.

Linda Ewing-Cobbs*, Larry KramerDagger , Mary Prasad*, Denise Niles Canales*, Penelope T. Louis§, Jack M. Fletcher*, Hilda Vollero*, Susan H. Landry*, and Kim Cheung*

From the Departments of * Pediatrics and Dagger  Radiology, University of Texas at Houston Health Science Center; and the § Department of Pediatrics, Baylor College of Medicine, Houston, Texas.

Objective.  To characterize neuroimaging, physical, neurobehavioral, and developmental findings in children with inflicted and noninflicted traumatic brain injury (TBI) and to identify characteristic features of inflicted TBI.

Methods and Patients.  Forty children, 0 to 6 years of age, hospitalized for TBI who had no documented history of previous brain injury were enrolled in a prospective longitudinal study. TBI was categorized as either inflicted (n = 20) or noninflicted (n = 20) based on the assessment of hospital and county protective services. Glasgow Coma Scale scores and neonatal history were comparable in both groups.

Outcome Measures.  Acute computed tomography/magnetic resonance imaging studies and physical findings were evaluated. Glasgow Outcome Scale scores, cognitive development, and motor functioning were assessed an average of 1.3 months after TBI. chi 2 analyses assessed differences in the distribution of findings in the inflicted and noninflicted TBI groups.

Results.  Signs of preexisting brain injury, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly, were present in 45% of children with inflicted TBI and in none of the children with noninflicted TBI. Subdural hematomas and seizures occurred significantly more often in children with inflicted TBI. Intraparenchymal hemorrhage, edema, skull fractures, and cephalohematomas were similar in both groups. Retinal hemorrhage was only identified in the inflicted TBI group. Glasgow Outcome Scale scores indicated a significantly less favorable outcome after inflicted than noninflicted TBI. Mental deficiency was present in 45% of the inflicted and 5% of the noninflicted TBI groups.

Conclusions.  Characteristic features of inflicted TBI included acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal hemorrhages, and significantly impaired cognitive function without prolonged impairment of consciousness.

Key words: child abuse, shaken baby syndrome, traumatic brain injury, cognition, outcome, infants, children, neuroimaging, Glasgow Outcome Scale, retinal hemorrhage.




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