Multidisciplinary Guidelines on the Identification, Investigation and Management of Suspected Abusive Head Trauma

Question 1

What is the definition of abusive head trauma?

Answer 1

Specific form of traumatic brain injury that is a consequence of violent shaking, impact or a combo
Characteristic injuries:
1. Intracranial hemorrhage
2. Retinal hemorrhage
3. Brain injury
4. Skull, rib, or long bone fracture

Question 2

What is the recommendation when AHT is suspected?

Answer 2

When Abusive Head Trauma is suspected, and even if not yet confirmed, it is mandatory to provide early notification to child protection so that they can begin their investigation by gathering appropriate background information.

Question 3

What are symptoms?

Answer 3

1. Lethargy
2. Decreased feeding
3. Irritability
4. Emesis
5. Respiratory distress
6. Apnea
7. Seizures
8. Altered LOC

Question 4

When should a full assessment for suspected AHT be considered?

Answer 4

1. An acute or chronic injury with inadequate,
   inconsistent, evolving or no explanation.
2. A severe head injury allegedly the result of a short fall or minor trauma.
3. An unexplained symptomatic head injury in a child who was well when he/she was last seen.
4. Subdural hemorrhage, retinal hemorrhage, rib, skull or metaphyseal fractures.

Question 5

What assessment is recommended in the context of potential AHT?

Answer 5

1. Ophthalmology exam
2. CBC w/ platelet number
3. Coagulation studies
4. Blood biochemistry (i.e. glu, lytes, metabolic screen, tox, microbiology)
5. Early neuroimaging - CT for acute cases
6. Skeletal survey

Question 6

What findings are strongly suggestive of AHT?

Answer 6

1. Traumatic retinoschisis

2. Diffuse multilayered retinal hemorrhages and subdural hematoma

Question 7

Which early consultations should occur in AHT?

Answer 7

1. A physician with expertise in child maltreatment.
2. An ophthalmologist, preferably one with paediatric expertise, to identify and document
   the retinal findings with photographs, if possible.
3. A neurosurgeon/ neurologist, preferably one
   with paediatric expertise.
4. A radiologist/ neuroradiologist with paediatric expertise.
5. Other consultations suggested by the clinical condition.