Analysis of missed cases of abusive head trauma

Context Abusive head trauma (AHT) is a dangerous form of child abuse that c an be difficult to diagnose in young children. Objectives To determine how frequently AHT was previously missed by physici ans in a group of abused children with head injuries and to determine facto rs associated with the unrecognized diagnosis. Design Retrospective chart review of cases of head trauma presenting betwee n January 1, 1990, and December 31, 1995. Setting Academic children's hospital. Patients One hundred seventy-three children younger than 3 years with head injuries caused by abuse. Main Outcome Measures Characteristics of head-injured children in whom diag nosis of AHT was unrecognized and the consequences of the missed diagnoses. Results Fifty-four (31.2%) of 173 abused children with head injuries had be en seen by physicians after AHT and the diagnosis was not recognized. The m ean time to correct diagnosis among these children was 7 days (range, 0-189 days). Abusive head trauma was more likely to be unrecognized in very youn g white children from intact families and in children without respiratory c ompromise or seizures. In 7 of the children with unrecognized AHT, misinter pretation of radiological studies contributed to the delay in diagnosis. Fi fteen children (27.8%) were reinjured after the missed diagnosis. Twenty-tw o (40.7%) experienced medical complications related to the missed diagnosis . Four of 5 deaths in the group with unrecognized AHT might have been preve nted by earlier recognition of abuse. Conclusion Although diagnosing head trauma can be difficult in the absence of a history, it is important to consider inflicted head trauma in infants and young children presenting with nonspecific clinical signs.