COMPARISON OF INTRACRANIAL COMPUTED TOMOGRAPHIC (CT) FINDINGS IN PEDIATRIC ABUSIVE AND ACCIDENTAL HEAD TRAUMA

Background. Child abuse specialists rely heavily on diagnostic neuroim aging. Objectives. Study objectives were: (1) to compare the frequenci es of six specific intracranial CT abnormalities in accidental and non accidental pediatric head trauma, and (2) to assess interobserver agre ement regarding these CT findings. Materials and methods. Three pediat ric radiologists blindly and independently reviewed cranial CT scans o f pediatric patients who sustained closed head trauma between 1991 and 1994. All patients were less than 4 years of age. Study cases include d thirty-nine (50 %) with nonaccidental head trauma and thirty-nine (5 0 %) with accidental head trauma. Each scan was evaluated for the pres ence or absence of the following six intracranial findings: (1) interh emispheric falx hemorrhage, (2) subdural hemorrhage, (3) large (non-ac ute) extra-axial fluid, (4) basal ganglia edema, (5) posterior fossa h emorrhage, and (6) frontal-parietal shearing tear(s). Interobserver ag reement was calculated as the percentage of total cases in which all r eviewers agreed a specific CT finding was present or absent. Diagnosis required independent agreement by all three pediatric radiologists. T he frequencies of these six intracranial CT abnormalities were compare d between the two study groups by Chi-square analysis and Fisher's exa ct test. Results. Interobserver agreement between radiologists was gre ater than 80 % for all. lesions evaluated, with the exception of front al-parietal shearing tear(s). Interhemispheric fair hemorrhage, subdur al hemorrhage, large (non-acute) extra-axial fluid, and basal ganglia edema were discovered significantly more frequently in non-accidental trauma (P less than or equal to.05). Conclusion. Although not specific for child abuse, discovery of these intracranial CT abnormalities in young patients should prompt careful evaluation of family and injury c ircumstances for indicators of nonaccidental trauma.