Abusive head trauma - Revision history

Elcatracho: /* Clinical Features */

2021-02-04T16:35:51Z

Clinical Features

← Older revision		Revision as of 16:35, 4 February 2021
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	*History concerning/red flags for [[child abuse]]		*History concerning/red flags for [[child abuse]]
	*[[Retinal hemorrhage]]		*[[Retinal hemorrhage]]
	**Most common manifestation of abusive head trauma		**Most common manifestation of abusive head trauma (as high as 85% in some retrospective reviews<ref>Morad Y, Kim YM, Armstrong DC, Huyer D, Mian M, Levin AV. Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome. Am J Ophthalmol. 2002;134(3):354-359. doi:10.1016/s0002-9394(02)01628-8</ref>)
	**In infants, virtually pathognomonic for nonaccidental trauma, especially when numerous and multilayered		**In infants, virtually pathognomonic for nonaccidental trauma, especially when numerous and multilayered
	**Due to vitreoretinal traction		**Due to vitreoretinal traction

Elcatracho: /* Clinical Features */

2021-02-04T16:30:45Z

Clinical Features

← Older revision		Revision as of 16:30, 4 February 2021
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	*History concerning/red flags for [[child abuse]]		*History concerning/red flags for [[child abuse]]
	*[[Retinal hemorrhage]]		*[[Retinal hemorrhage]]
			**Most common manifestation of abusive head trauma
	**In infants, virtually pathognomonic for nonaccidental trauma, especially when numerous and multilayered		**In infants, virtually pathognomonic for nonaccidental trauma, especially when numerous and multilayered
	**Due to vitreoretinal traction		**Due to vitreoretinal traction

ClaireLewis: /* Evaluation */

2019-10-05T20:17:16Z

Evaluation

← Older revision		Revision as of 20:17, 5 October 2019
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	**Consider CPK and platelet function studies if extensive bruising is present		**Consider CPK and platelet function studies if extensive bruising is present
	**If trauma labs are abnormal, obtain a CT of abdomen/pelvis with IV contrast		**If trauma labs are abnormal, obtain a CT of abdomen/pelvis with IV contrast
	*Consider a dilated [[fundoscopic]] ~~exam~~ if under 2 years		*Consider a dilated [[fundoscopic exam]] if under 2 years
	*Photograph injuries		*Photograph injuries
	*Obtain a social work consult		*Obtain a social work consult
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	*PTH, iCa, 25-hydroxy-Vit D, 1,25-dihydroxy-Vit D		*PTH, iCa, 25-hydroxy-Vit D, 1,25-dihydroxy-Vit D
	*vW panel (vW AT, ristocetin cofactors, factor VIII)		*vW panel (vW AT, ristocetin cofactors, factor VIII)


	==Management==		==Management==

ClaireLewis at 20:16, 5 October 2019

2019-10-05T20:16:59Z

← Older revision		Revision as of 20:16, 5 October 2019
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	*Skeletal survey for all children < 2 years of age, non-verbal, or severe developmental delay. Note: Follow-up skeletal survey should be performed within 10 to 14 days		*Skeletal survey for all children < 2 years of age, non-verbal, or severe developmental delay. Note: Follow-up skeletal survey should be performed within 10 to 14 days
	**Skull AP and lateral view (left and right)		**Skull AP and lateral view (left and right)
	**Chest AP and lateral view		**[[CXR\|Chest]] AP and lateral view
	**Right and left oblique of the chest		**Right and left oblique of the chest
	**AP of the abdomen to include pelvis and hips		**AP of the abdomen to include pelvis and hips
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	**Consider CPK and platelet function studies if extensive bruising is present		**Consider CPK and platelet function studies if extensive bruising is present
	**If trauma labs are abnormal, obtain a CT of abdomen/pelvis with IV contrast		**If trauma labs are abnormal, obtain a CT of abdomen/pelvis with IV contrast
	*Consider a dilated fundoscopic exam if under 2 years		*Consider a dilated [[fundoscopic]] exam if under 2 years
	*Photograph injuries		*Photograph injuries
	*Obtain a social work consult		*Obtain a social work consult
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	==Disposition==		==Disposition==
	*~~Dependant~~ on severity of injuries and safety upon discharge		*Dependent on severity of injuries and safety upon discharge

	==See Also==		==See Also==

ClaireLewis at 00:31, 28 January 2019

2019-01-28T00:31:41Z

← Older revision		Revision as of 00:31, 28 January 2019
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	==References==		==References==
	<references/>		<references/>
			*Tintinalli's
			*Current Diagnosis & Treatment: Pediatrics, 24e,
			*[[https://bestpractice.bmj.com/topics/en-gb/688 BMJ Best Practices]]

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Trauma]]		[[Category:Trauma]]

ClaireLewis: /* Clinical Features */

2019-01-27T22:58:56Z

Clinical Features

← Older revision		Revision as of 22:58, 27 January 2019
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	*Majority of patients <1 year old		*Majority of patients <1 year old
	*History concerning/red flags for [[child abuse]]		*History concerning/red flags for [[child abuse]]
	*Retinal ~~hemorrhages~~		*[[Retinal hemorrhage]]
	**In infants, virtually pathognomonic for nonaccidental trauma, especially when numerous and multilayered		**In infants, virtually pathognomonic for nonaccidental trauma, especially when numerous and multilayered
	**Due to vitreoretinal traction		**Due to vitreoretinal traction
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	*Cutaneous ecchymoses: to face/head and other areas where patient grabbed or sustained impact		*Cutaneous ecchymoses: to face/head and other areas where patient grabbed or sustained impact
	*Other injuries associated with [[child abuse]], especially long bone and/or [[rib fractures]]		*Other injuries associated with [[child abuse]], especially long bone and/or [[rib fractures]]

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Template:Child abuse DDX}}		{{Template:Child abuse DDX}}

ClaireLewis at 22:54, 27 January 2019

2019-01-27T22:54:38Z

← Older revision		Revision as of 22:54, 27 January 2019
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	{{Template:Child abuse DDX}}		{{Template:Child abuse DDX}}


	~~==Evaluation==~~
	==Evaluation==		==Evaluation==
	*Skeletal survey for all children < 2 years of age, non-verbal, or severe developmental delay. Note: Follow-up skeletal survey should be performed within 10 to 14 days		*Skeletal survey for all children < 2 years of age, non-verbal, or severe developmental delay. Note: Follow-up skeletal survey should be performed within 10 to 14 days

ClaireLewis: Created page with "==Background== *Current term for constellation of injuries that result from nonaccidental trauma involving forcefully shaking infant and/or any direct head impact **may be..."

2019-01-27T22:54:15Z

Created page with "==Background== *Current term for constellation of injuries that result from nonaccidental trauma involving forcefully shaking infant and/or any direct head impact **may be..."

New page

==Background==
*Current term for constellation of injuries that result from [[nonaccidental trauma]] involving forcefully shaking infant and/or any direct head impact
**may be referred to as "shaken baby syndrome" in lay press or old literature
*Injuries result of repetitive acceleration-deceleration and rotational forces (akin to whip lash) as well as direct blunt trauma from impact with objects or assailant

==Clinical Features==
*Majority of patients <1 year old
*History concerning/red flags for [[child abuse]]
*Retinal hemorrhages
**In infants, virtually pathognomonic for nonaccidental trauma, especially when numerous and multilayered
**Due to vitreoretinal traction
**May lead to [[retinal detachment]]
**May also have other eye findings (e.g. subconjunctival hemorrhage, [[hyphema]], ecchymoses
*Signs of [[Pediatric head trauma|traumatic brain injury]]
**[[SDH]] (most common intracranial injury), [[skull fracture]], diffuse axonal injury
**[[Altered mental status (peds)|AMS]], lethargy, [[seizure (peds)|seizure]], irritability/inconsolable [[crying infant|crying]]
*Cutaneous ecchymoses: to face/head and other areas where patient grabbed or sustained impact
*Other injuries associated with [[child abuse]], especially long bone and/or [[rib fractures]]

==Differential Diagnosis==
{{Template:Child abuse DDX}}

==Evaluation==
==Evaluation==
*Skeletal survey for all children < 2 years of age, non-verbal, or severe developmental delay. Note: Follow-up skeletal survey should be performed within 10 to 14 days
**Skull AP and lateral view (left and right)
**Chest AP and lateral view
**Right and left oblique of the chest
**AP of the abdomen to include pelvis and hips
**AP and lateral spine to include cervical, thoracic, and lumbar vertebrae
**AP bilateral humerus
**AP bilateral forearms
**AP bilateral femurs
**AP bilateral tibia and fibula
**Posterior view of the hands
**Dorsoplantar view of the feet
*[[Head CT]] without contrast for any child < 1 year with suspicion of abuse or >1 year with concerning signs of head trauma
*Trauma labs: CBC, CMP, PT, PTT, lipase, and urinalysis (looking for blood; use bag specimen). Consider urine tox screen
**Consider CPK and platelet function studies if extensive bruising is present
**If trauma labs are abnormal, obtain a CT of abdomen/pelvis with IV contrast
*Consider a dilated fundoscopic exam if under 2 years
*Photograph injuries
*Obtain a social work consult

===Inpatient Workup<ref>Children's Hospital of Georgia NAT Workup Protocol. Medical College of Georgia at Augusta University. Last reviewed 2016.</ref>===
*CBC
*CMP, Mg, phos
*PT/INR/aPTT, fibrinogen
*PTH, iCa, 25-hydroxy-Vit D, 1,25-dihydroxy-Vit D
*vW panel (vW AT, ristocetin cofactors, factor VIII)

==Management==
*Treat any identified injuries
*Ophtho consult for retinal hemorrhages
*Report abuse concerns to appropriate authority

==Disposition==
*Dependant on severity of injuries and safety upon discharge

==See Also==
*[[Nonaccidental trauma]]
*[[Pediatric head trauma]]
*[[Trauma (peds)]]

==External Links==

==References==
<references/>

[[Category:Pediatrics]]
[[Category:Trauma]]