Head injury depth may indicate abuse cases in young children

Dartmouth-Hitchcock Medical Center physician Dr. Kent Hymel recently examined the differences in the causes, mechanisms, injuries, and outcomes of children under three years of age with various “greatest depths” of head injury. The hope is that greater knowledge of causes and mechanisms of injury can provide more effective methods to prevent and provide protection from child abuse. The findings were recently published in the Journal of Pediatrics.

For infants and young children, the traumatic brain injuries that resulted from inadvertent, diminutive falls are most often superficial. On the contrary, head injuries that are a result of child abuse tend to penetrate deeper within the brain and are more widespread.

Abusive head trauma has been identified as the leading cause of traumatic death and disability within the first 36 months of life of young children, according to the Pediatric Brain Injury Research Network.

The subjects of the research study, 54 infants and young children under three years of age who had been hospitalized with varying degrees of acute head trauma, participated at nine sites across the country for a period of six months. The research team collected and analyzed clinical as well as imaging data and systematically interviewed the subjects’ caregivers. Brain development evaluations were completed and sample groups with varying “greatest depths of injury” were compared to one another.

Results of the study indicate that for children within 36 months of age, head injury depth is a “useful indicator” of causes and mechanisms of sustained head trauma. These results have the potential to provide profound implications for diagnosing, predicting, and solving cases of child abuse.

Driven by the results of this study, Hymel, the lead researcher, created the PediBIRN: Pediatric Brain Injury Research Network-a research group which focuses on collecting data associated with cases of child abuse.

Doctors often struggle to report cases of head injuries caused by abuse because of a lack of both concrete diagnostic guidelines and “reasonable medical certainty” to identify such cases. A 1999 study showed that 31 percent of children sustaining abuse-related head injuries were “missed or misdiagnosed.” The primary objective of PediBIRN is to use their research to compose a “Clinical Prediction Rule” for pediatric head trauma caused by abuse in order to diminish this intolerably high diagnostic uncertainty.