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0090 Abusive head trauma: needs more attention
  1. H Pendharkar,
  2. N Pruthi,
  3. N Rao,
  4. D Shukla,
  5. J Vijaysagar,
  6. K Jangam,
  7. K Thennarasu,
  8. N Kamble,
  9. S Amudhan
  1. National Institute of Mental Health and Neurosciences, Bangalore, India


Statement of purpose To review the clinical data, imaging and associated work up of children suspected of AHT at our institute. About a hundred pediatric patients between newborn to 3 years with head injury are attended to annually in our institute. A pilot study done previously had drawn attention to the prevalence of possible AHT in Indian set up.

Methods/Approach The admission non contrast CT brain of children (newborn to 3 years) who attended the institute casualty with alleged head trauma and were suspected of AHT between 2016–2020 was reviewed. Of these 18 patients, there were 12 males & 6 females, age ranging from 1m to three years (avg age 14.7 months).

Results The imaging findings included: convexity SDH (10/18), tentorial SDH (2/18) interhemispheric fissure SDH (4/18), parenchymal hemorrhage (1/18), sub arachnoid hemorrhage (1/18), hypoxic ischemic injury (2/18), skull fractures (4/18). The clinical history was often misleading. Despite suspecting AHT, the work up for AHT was incomplete and included: CT brain (17/18), chest x-ray (11/18), complete skeletal survey (4/18), MRI brain (6/18), fundoscopy (6/18).

Conclusion Based on the clinical profile, imaging findings and related work up a few cases were considered to be possible AHT. The imaging though points to possible AHT, extensive work up is needed to assert or refute AHT.

Significance This analysis highlights that when AHT is suspected, the work up of cases to assert or refute AHT needs to be complete. If the clinical & imaging data of all children under 3 years of age, attending our institute and with findings pointing to AHT were evaluated; a much larger number of cases could possibly be identified thus changing the perception that AHT is not as rampant in India. It would then help work on prevention.

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