Abusive Head Trauma in Infants: Incidence and Detection of Prior Brain Injury

Diagnosis of abusive head trauma (AHT) is challenging; clinical signs are non-specific and perpetrator confessions are rare. Moreover, many infants sustain multiple episodes of abuse before presenting to medical practitioners. The objective of this study was to quantify the incidence of prior presentations with features of brain injury in AHT, and to compare these figures to those in non-abusive head trauma (non-AHT). Data on children under the age of two years who were assessed for AHT by the Child Protection Unit of Sydney Children's Hospital between 2008 and 2017 were collected, and AHT cases were compared with non-abusive cases. Of the 167 cases assessed for head trauma, 26 per cent had at least one prior presentation to medical care. This was 42 per cent of the AHT cases, and 11 per cent of the non-AHT cases. Odds ratio calculations revealed infants with AHT were 5.7 times more likely to have had a prior presentation than children with non-AHT (CI = 2.4-13.17,p< 0.001. Infants with AHT are much more likely than infants with non-AHT to have presented previously to medical practitioners. This difference suggests that there is an early diagnostic window within which abuse can be detected before it continues or escalates. Careful evaluation of an infant is of paramount importance, and may save a life. '[Aims] to quantify the incidence of prior presentations with features of brain injury in AHT, and to compare these figures to those in non-abusive head trauma' Key Practitioner Messages Medical practitioners should consider the possibility of brain injury in a child presenting with non-specific symptoms, and consider that this brain injury could be abusive in nature. Suspicions of abusive head trauma should be increased if the child has presented with signs consistent with brain injury before. Suspicions of abusive head trauma should be increased if there is no mechanism of an injury provided by the child's carer.