NEUROIMAGING, PHYSICAL, AND DEVELOPMENTAL FINDINGS AFTER INFLICTED AND NONINFLICTED TRAUMATIC BRAIN INJURY IN YOUNG-CHILDREN

Objective. To characterize neuroimaging, physical, neurobehavioral, an d developmental findings in children with inflicted anti noninflicted traumatic brain injury (TBI) and to identify characteristic features o f inflicted TBI. Methods and Patients, Forty children, 0 to 6 years of age, hospitalized for TBI who had no documented history of previous b rain injury were enrolled in a prospective longitudinal study. TBI was categorized as either inflicted (n = 20) or noninflicted (n = 20) bas ed on the assessment of hospital and county protective services. Glasg ow Coma Scale scores and neonatal history were comparable in both grou ps. Outcome Measures. Acute computed tomography/magnetic resonance ima ging studies and physical findings were evaluated. Glasgow Outcome Sca le scores, cognitive development, and motor functioning were assessed an average of 1.3 months after TBI. chi(2) analyses assessed differenc es in the distribution of findings in the inflicted and noninflicted T BI groups. Results. Signs of preexisting brain injury, including cereb ral atrophy, subdural hygroma, and ex vacuo ventriculomegaly, were pre sent in 45% of children with inflicted TBI and in none of the children with noninflicted TBI. Subdural hematomas and seizures occurred signi ficantly more often in children with inflicted TBI. Intraparenchymal h emorrhage, edema, skull fractures, and cephalohematomas were similar i n both groups. Retinal hemorrhage was only identified in the inflicted TBI group. Glasgow Outcome Stale scores indicated a significantly les s favorable outcome after inflicted than noninflicted TBI. Mental defi ciency was present in 45% of the inflicted and 5% of the noninflicted TBI groups. Conclusions. Characteristic features of inflicted TBI incl uded acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal he morrhages, and significantly impaired cognitive function without prolo nged impairment of consciousness.