Characteristics and Diagnosis of Paediatric Abusive Head Trauma

MedicīnaVeselības aprūpeMedicineHealth CareBackground Abusive head trauma (AHT), also known as “shaken baby syndrome” is a major cause of morbidity and mortality in children, that over recent years have been widely discussed. Rulings in court have led to discussions about the validity of the diagnosis itself. With modern imaging techniques, a great variety of options are available to the physician, and it is important to know which ones are best to use in case of AHT. Aim of the thesis To review research studies, medical recommendations and literature reviews on clinical characteristics of abusive head trauma and how it could be diagnosed in means of anamnesis, physical examination, laboratory studies, diagnostic imaging, and pathology. Tasks of the thesis I will in this literature review compile all relevant research publications on clinical characteristics and diagnosis of abusive head trauma. I will analyse the gathered information and select the diagnostic findings most commonly associated with abusive head trauma. Initially, I will give an introduction to abusive head trauma including definition and historical background, followed by common risk factors and how abusive head trauma can be distinguished from accidental head trauma. Thereafter I will compare the diagnostic findings gathered from the references used, to finally suggest diagnostic steps for confirming abusive head trauma in children. Material and methods used In this literature review, searches were made on electronic databases (PubMed, Google Scholar, ScienceDirect) as well as in reference lists of relevant studies and articles. 472 potential articles were found. Articles were selected assessing four criteria: diagnostic features, participants (children below the age of 5 years), setting and relation to topic. Out of the 472 articles identified, 67 articles were included into this review, followed by 32 articles from reference lists of retrieved articles. The selected studies were evaluated according to their evidence level and grade of recommendation. Conclusion The diagnosis of AHT should be done in a multidisciplinary approach, where all clinical data and imaging results needs to be considered together with the given explanation of trauma in a team of different specialists. Most of the publications on clinical characteristics and diagnosis of AHT have a low evidence level. Most studies and reviews of AHT agree that there are no signs that are specific to AHT only, and there is a broad overlap of findings between abusive and accidental head trauma. Hypothesis can therefore be considered as being true.Background Abusive head trauma (AHT), also known as “shaken baby syndrome” is a major cause of morbidity and mortality in children, that over recent years have been widely discussed. Rulings in court have led to discussions about the validity of the diagnosis itself. With modern imaging techniques, a great variety of options are available to the physician, and it is important to know which ones are best to use in case of AHT. Aim of the thesis To review research studies, medical recommendations and literature reviews on clinical characteristics of abusive head trauma and how it could be diagnosed in means of anamnesis, physical examination, laboratory studies, diagnostic imaging, and pathology. Tasks of the thesis I will in this literature review compile all relevant research publications on clinical characteristics and diagnosis of abusive head trauma. I will analyse the gathered information and select the diagnostic findings most commonly associated with abusive head trauma. Initially, I will give an introduction to abusive head trauma including definition and historical background, followed by common risk factors and how abusive head trauma can be distinguished from accidental head trauma. Thereafter I will compare the diagnostic findings gathered from the references used, to finally suggest diagnostic steps for confirming abusive head trauma in children. Material and methods used In this literature review, searches were made on electronic databases (PubMed, Google Scholar, ScienceDirect) as well as in reference lists of relevant studies and articles. 472 potential articles were found. Articles were selected assessing four criteria: diagnostic features, participants (children below the age of 5 years), setting and relation to topic. Out of the 472 articles identified, 67 articles were included into this review, followed by 32 articles from reference lists of retrieved articles. The selected studies were evaluated according to their evidence level and grade of recommendation. Conclusion The diagnosis of AHT should be done in a multidisciplinary approach, where all clinical data and imaging results needs to be considered together with the given explanation of trauma in a team of different specialists. Most of the publications on clinical characteristics and diagnosis of AHT have a low evidence level. Most studies and reviews of AHT agree that there are no signs that are specific to AHT only, and there is a broad overlap of findings between abusive and accidental head trauma. Hypothesis can therefore be considered as being true