Child Abuse Research Today is a free monthly online journal that collates and summarizes the latest research about Child Abuse, including details on family violence, examinations, long-term effects, psychiatrics disorders. | ||||||||
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Non-accidental subdural haemorrhage in Hong Kong: incidence, clinical features, management and outcome.Sun DT, Zhu XL, Poon WS Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories East, Hong Kong. OBJECTIVE: We aim to identify the incidence and the characteristics of non-accidental subdural haemorrhage in Hong Kong in children under the age of 5 years. METHOD: Eighteen children aged below 5 years presented with subdural haemorrhage without a history of significant trauma were studied. Clinical features and the work-up process for probable child abuse were analysed. RESULTS: Sixteen combined case conferences were held, and eleven cases were concluded to be genuine child abuse cases of non-accidental head injury (incidence=1.5 per 100,000 children <5 years old per year). Among these cases, the most common presentation in the younger age group (age<1 year) was seizure (5/7), whilst that in the older age group (age 1-4 years) was coma (4/4, two of these patients also had seizure). One patient in the younger age group and three (3/4) of the older age group were found to have multiple unexplained bruises, suggesting that, in older children, direct impact injury played an important role. Five (5/7) children in the younger age group and all four children in the older age group had retinal haemorrhage. Coma on admission was associated with an unfavourable outcome (6/7 vs 0/4, p=0.015). CONCLUSIONS: Sixty-one percent of childhood subdural haemorrhage (11/18) without a history of significant trauma were genuine child abuse cases and should all be investigated for probable "non-accidental injury". An organised protocol involving a multi-disciplinary team is mandatory. Published 18 May 2006 in Childs Nerv Syst, 22(6): 593-8.
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