Abusive head trauma and the radiologist

Author(s): Dr Neil Stoodley

Hospital: Bristol Royal Hospital For Children

Reference: RAD Magazine, 41, 477, 15-16


Abusive head trauma (AHT) is the current preferred term for what used to be called non-accidental head injury and, earlier, shaken baby syndrome. Discussion of the topic always generates interest and debate as, although most clinicians involved in the day-to-day management of infants and children who have sustained head injuries of all types recognise the constellation of clinical and imaging features that can strongly suggest AHT, there is a spectrum of opinion among the wider medical community and elsewhere.

At either end of that spectrum some hold the view that it is not possible to injure a child by shaking and others that all such injuries occur as a result of a severe, violent act. Differentiating AHT from other types of head trauma and from other naturally occurring medical conditions is obviously extremely important, and to get it wrong has potentially serious consequences for the child and/or family. Radiology and a radiology report can only be one part of the whole clinical picture and if the ultimate conclusion of the multidisciplinary team is that the child has suffered AHT, the radiologist should be reassured that that conclusion will not have been reached on the basis of the radiological features alone. The importance of recognising AHT and of raising it as a possible component of a differential diagnosis is emphasised by the fact that AHT is the most common cause of death in infants and children who have been physically abused. Overall mortality is around 30% and around 50% of survivors can be expected to show varying degrees of physical and cognitive disability. The majority of cases occur in infants under six months of age and almost all other cases occur in children under the age of two years.

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