Child Protection Evidence - Neurological injuries

Child Protection Evidence is a resource available for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system. This systematic review evaluates the literature on abusive and non-abusive head trauma.

About the review

Abusive head trauma is associated with high levels of morbidity and mortality.

The review seeks to help clinicians by highlighting the areas of the literature which show the features most indicative of abusive head trauma. In addition, newer high quality studies have also allowed further developments in distinguishing abusive from non-abusive head trauma radiologically.

This systematic review evaluates the scientific literature on neurological injuries published up until August 2014.

It aims to answer the following clinical questions:

  • What neuroradiological investigations are indicated to identify abusive central neurological system injury in children?
  • What are the distinguishing clinical features of abusive head trauma in children?
  • What neuroradiological features distinguish abusive from non-abusive head trauma?
  • Can you date inflicted intracranial injuries in children neuroradiologically?

The implications for practice and research, and other useful references are included in the review.

Key findings

  • In an acutely ill child, a computerised tomography scan (CT) is the preferred imaging technique, due to its widespread availability; ability to identify and localise acute extra-axial bleeding.
  • Ultrasound scanning should never be used as a diagnostic investigation since, whilst it found some features, it missed many others.
  • High resolution ultrasound scans (USS) may have some advantage as a secondary investigation in experienced hands to monitor or follow the development of a lesion already identified on CT or MRI disorders.
  • It is vital that all children with suspected abusive head trauma (AHT) have their eyes examined thoroughly by an ophthalmologist (dilated pupils and indirect fundoscopy) for the presence of retinal haemorrhage.
  • Skeletal survey including oblique views of the ribs should be performed in all children less than two years of age with suspected AHT.
  • Certain features (retinal haemorrhage, apnoea) appear to correlate strongly with AHT rather than non-abusive head trauma in children less than three years of age.
  • Magnetic resonance imaging (MRI) techniques and availability are improving, however this field would benefit from further research around aging intracranial injuries and prospective studies relating neurological findings to clinical factors of abusive and non-abusive head trauma.

Disclaimer: This is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates

Original reviews and content © Cardiff University, funded by NSPCC
Published by RCPCH July 2017

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.