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>Characteristics distinguishing abusive head trauma from accidental head trauma in infants with traumatic intracranial hemorrhage in Japan
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Characteristics distinguishing abusive head trauma from accidental head trauma in infants with traumatic intracranial hemorrhage in Japan
Aim To identify markers for detecting abusive head trauma ( AHT ) and its characteristics in the Japanese population. Methods We retrospectively reviewed the clinical records of 166 infants with traumatic intracranial hemorrhage between 2002 and 2013 in three tertiary institutions in Japan. The infants were classified into AHT (57), suspected AHT (24), and accidental (85) group based on the defined criteria. We compared clinical presentations and computed tomography findings among these three groups and also compared age distribution of infants with AHT in our study to those in the USA. Results Age distribution of AHT cases is significantly higher in our study than in the USA (P 0.001). The rates of male sex, bruising, retinal hemorrhage, subdural hematoma, cerebral edema, and neurological sequelae were significantly higher, and those of skull fracture and scalp finding were significantly lower, in the AHT group than in the accidental group (P 0.05). In the multivariable analysis of the infants with subdural hematoma, absence of skull fracture (odds ratio = 42.1; 95% confidence interval, 3.5–507.7, P = 0.003) was associated with AHT . Conclusions The age range of AHT in Japan is significantly different from that of countries in Europe and North America because of familial and sociocultural situations. Absence of bruising, and rib or long bone fractures did not reduce the likelihood of AHT . Subdural hematoma without findings of an impact to the head strongly suggested AHT . Abusive head trauma is a global problem, however, diagnosis and defensive measures likely need to be tailored to accommodate cultural risk factors. We retrospectively reviewed the clinical records of 166 infants with traumatic intracranial hemorrhage between 2002 and 2013 in three tertiary institutions of Japan. Characteristics of abusive head trauma in Japan were partially different from those in other developed countries due to familial and sociocultural situations. We conclude that abusive head trauma is a global problem, and diagnosis and interventions for prevention need to be tailored for cultural risk factors.
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机译：目的确定在日本人群中检测滥用性颅脑外伤（AHT）及其特征的标志物。方法我们回顾性回顾了2002年至2013年日本三所大专院校166例创伤性颅内出血婴儿的临床记录。根据定义的标准，将婴儿分为AHT（57），可疑AHT（24）和意外（85）组。我们比较了这三组患者的临床表现和计算机断层扫描结果，还比较了本研究与美国的AHT婴儿的年龄分布。结果在我们的研究中，AHT病例的年龄分布明显高于美国（ P <0.001）。与意外组相比，AHT组的男性，青肿，视网膜出血，硬膜下血肿，脑水肿和神经后遗症的发生率显着更高，而颅骨骨折和头皮发现的发生率显着低于意外组（ P <0.05）。在硬膜下血肿婴儿的多变量分析中，没有颅骨骨折（几率= 42.1; 95％置信区间为3.5-507.7，P = 0.003）与AHT相关。结论由于家庭和社会文化状况的原因，日本的AHT年龄范围与欧洲和北美的国家存在显着差异。没有瘀伤，肋骨或长骨骨折并没有降低AHT的可能性。硬膜下血肿未发现对头部有影响，强烈建议进行AHT。虐待性头部创伤是一个全球性问题，但是，可能需要针对文化风险因素量身定制诊断和防御措施。我们回顾性地回顾了2002年至2013年间日本三大专科医院收治的166例颅脑外伤婴儿的临床记录。由于家庭和社会文化状况的影响，日本的头部外伤特征与其他发达国家相比有所不同。我们得出结论，虐待性头部创伤是一个全球性问题，需要针对文化风险因素量身定制预防性诊断和干预措施。
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