EPIDURAL HEMORRHAGE - IS IT ABUSE

Objective. To determine whether children presenting with epidural hemo rrhage (EDH) are as likely to have been abused as are children present ing with subdural hemorrhage (SDH). Design. Retrospective chart review . Setting. Level I regional trauma center and a regional children's ho spital. Patients. All children at both institutions 3 years old or you nger with a diagnosis of EDH or SDH identified by a search of the comp uterized trauma registry and hospital medical records from 1985 throug h 1991. Measurement and Results. Complete records were found for 93 of 94 eligible subjects. The diagnosis of accidental or inflicted injury was ascertained from the patient's hospital medical record or the rec ords of Child Protective Services. Of all subjects (n = 93), 52% (48/9 3) were male and the median age was 15 months. Abuse was diagnosed in 47% (28/59) of children with SDH and 6% (2/34) of those with EDH. Othe r significant injuries were found in 47% of children with SDH and 18% of children with EDH. There was no statistically significant differenc e between the two groups with respect to the likelihood of identifying a skull fracture, the need for surgical evacuation of the hemorrhage, or mortality. Conclusions. Our data are consistent with current biome chanical concepts of intracranial injury. EDHs result from brief linea r contact forces that commonly occur in unintentional falls. SDHs are caused by global high-energy rotational acceleration/deceleration forc es that are commonly generated in episodes of abuse. Compared with SDH , EDH rarely results from abuse.