Universität zu Köln

Hahnemann, Maria L., Kronsbein, Katharina, Karger, Bernd, Feld, Katharina, Banaschak, Sibylle, Helmus, Janine, Mentzel, Hans-Joachim, Pfeiffer, Heidi and Wittschieber, Daniel (2023). Characterization of subdural collections in initial neuroimaging of abusive head trauma: Implications for forensic age diagnostics and clinical decision-making. Eur. J. Radiol., 159. CLARE: ELSEVIER IRELAND LTD. ISSN 1872-7727

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Abstract

Purpose: Subdural collections (SDCs) represent a key finding in abusive head trauma (AHT), a serious form of child physical abuse. Common SDC entities in this context are subdural hematoma (SDH), subdural hygroma (SDHy), subdural hematohygroma (SDHHy), and chronic subdural hematoma (cSDH). The present study examines the prevalence of the different SDC entities and investigates the influence of the SDC diagnosis on the forensic age estimation of the injury. Methods: In this retrospective multi-center study from three German university hospitals of a 10-year period, the initial neuroimaging material (CT or MRI) of 56 children (36 males, 20 females; age median 3.9 months) with medico-legally well-documented AHT was analyzed. SDCs were characterized by determining presence, location, extension, and visual appearance, by assigning to one of the five entities, and by categorizing with three different classification systems, one of which represents a novel system based on focality and Mixed Appearance Pattern and especially developed for children with AHT. The data were correlated with demographic and clinical data. By means of court files, AHT cases were also sub-divided into confession (n = 14) and non-confession cases (n = 42) and then compared. Results: Most cases showed a multifocal presence of SDCs (96.4%) and the presence of a Mixed Appearance Pattern (82.1%). The most common SDC entity was the heterogeneous variant of the SDHHy (66.1%). The cSDH occurred infrequently only (3.6%). Our novel classification system illustrates that unifocal SDCs rarely occur in AHT, and that more complex SDC patterns are common. In nearly all cases (94.6%), additional signs of recently caused brain injury were present beside the SDCs. Comparison between confession and non-confession groups did not reveal any significant differences, indicating that the diagnostic criteria of AHT are robust. Conclusions: Although precise dating of SDCs based on initial neuroimaging alone remains unrealistic, the exact diagnosis of the SDC entity provide an important basis for differentiation between acute trauma and chronic post-traumatic state. Therefore, especially the confirmation or exclusion of subdural neomembranes, that define the cSDH, should be considered indispensable.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hahnemann, Maria L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kronsbein, Katharina UNSPECIFIED UNSPECIFIED UNSPECIFIED Karger, Bernd UNSPECIFIED UNSPECIFIED UNSPECIFIED Feld, Katharina UNSPECIFIED UNSPECIFIED UNSPECIFIED Banaschak, Sibylle UNSPECIFIED UNSPECIFIED UNSPECIFIED Helmus, Janine UNSPECIFIED UNSPECIFIED UNSPECIFIED Mentzel, Hans-Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfeiffer, Heidi UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittschieber, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-677556
DOI:	10.1016/j.ejrad.2022.110652
Journal or Publication Title:	Eur. J. Radiol.
Volume:	159
Date:	2023
Publisher:	ELSEVIER IRELAND LTD
Place of Publication:	CLARE
ISSN:	1872-7727
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INFANTS; INJURIES; CHILDREN; HEMORRHAGE; HEMATOMAS Multiple languages Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/67755