SUBDURAL HEMATOMAS IN CHILDREN UNDER 2 YEARS - ACCIDENTAL OR INFLICTED - A 10-YEAR EXPERIENCE

Objective: The aim of this study was to determine the relative frequen cy of child abuse, accidents and disease as a cause of subdural hemato mas in children under 2 years of age, and to determine the main clinic al features at presentation, that may help to distinguish these groups of patients. Method: A retrospective review was undertaken of the med ical records of all children under 2 years of age admitted to the Roya l Alexandra Hospital for Children with the diagnosis of subdural hemat oma in the 10-year period January 1987 to December 1996. Results: Thir ty eight children were identified with subdural hematomas during the s tudy period. The commonest cause was nonaccidental injury in 55% of ca ses, accidents in 39% and nontraumatic causes (6%) made up the remaind er. The nonaccidental injury cases were significantly younger than the accidentally injured children. The most important clinical features w ere the significantly higher incidence of retinal hemorrhages and asso ciated long bone and rib fractures in the abuse group. Delay in presen tation for medical evaluation was also more commonly seen in the abuse d children. Conclusion: Nonaccidental injury is the commonest cause of subdural hematomas in children under 2 years of age. The presence of retinal hemorrhages, bone and rib fractures, delay in presentation and the young age of the infants, suggests child abuse is the most likely cause of these injuries. (C) 1998 Elsevier Science Ltd.