Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma
Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma
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DOI：
10.1007/s00247-018-4237-2
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发表时间：
2018-12-01
影响因子：
2.3
通讯作者：
Patterson, Richard J.
中科院分区：
文献类型：
--
作者：
Ronning, Meghann M.;Carolan, Patrick L.;Patterson, Richard J.
研究背景头部虐待伤（AHT）是12个月以下婴儿硬膜下出血（SDH）的最常见原因。影像学上所见的颅顶旁凝块形成与AHT引起的SDH有关。关于这些发现的研究很少;据我们所知，还没有进行包括对照的研究。目的描述与SDH和意外创伤患者相比，SDH和AHT婴儿头部计算机断层扫描（CT）上的颅顶旁血块，并评估在已知的意外头部创伤的情况下，在没有SDH的情况下的颅顶旁血块。从2004年至2014年回顾性确定了CT扫描显示SDH的12个月龄。盲法，独立审查的所有CT扫描的血块形成在parasomedirecture进行的儿科neuroradiologist. ResultsNine 9例患者有资格进行分析。平均年龄4个月。57人（57.6%）为男性。55例（55.6%）患者被确定为患有AHT，22例（22.2%）患者有意外创伤。45例（81.2%）AHT患者在CT扫描中存在颅顶旁血凝块，而8例（36.4%）意外创伤患者存在颅顶旁血凝块。与没有头顶旁血栓的患者相比，有头顶旁血栓的患者更可能患有AHT（66.2% vs. 32.3%，P=0.001），损伤机制未知（69.1%比32.3%，P=0.015）、视网膜出血（75%比35.5%，P=0.002）和缺氧缺血性改变（25%比0%，P=0.002）。与无头顶旁血栓的患者相比，有头顶旁血栓的患者发生AHT的几率是无头顶旁血栓患者的8倍。匹配的对照组患者进行头部CT扫描，由于意外头部损伤的历史，没有SDH被确定（n=87）;在对照组中没有患者parasocellular ventralclots.ConclusionThe发现parasocellular ventralclotson CT扫描应提高怀疑滥用，并提示进一步调查，特别是在设置没有已知的，不确定的或不一致的损伤机制。
BackgroundAbusive head trauma (AHT) is the most common cause of subdural hemorrhage (SDH) in infants younger than 12months old. Clot formation in the parasagittal vertex seen on imaging has been associated with SDH due to AHT. There have been very few studies regarding these findings; to our knowledge, no studies including controls have been performed.ObjectiveTo describe parasagittal vertex clots on head computed tomography (CT) in infants with SDH and AHT compared to patients with SDH and accidental trauma, and to evaluate for parasagittal vertex clots in the absence of SDH in the setting of known accidental head trauma.Materials and methodsAll infants younger than 12months old with SDH present on CT scan were retrospectively identified from 2004 to 2014. Blinded, independent review of all CT scans for clot formation at the parasagittal vertex was performed by a pediatric neuroradiologist.ResultsNinety-nine patients were eligible for analysis. Mean age was 4months. Fifty-seven (57.6%) were male. Fifty-five (55.6%) patients were identified as having AHT and 22 (22.2%) had accidental trauma. Forty-five (81.2%) patients with AHT had parasagittal vertex clots present on CT scan compared to 8 (36.4%) patients with accidental trauma. Compared to patients without parasagittal vertex clots, those with parasagittal vertex clots were more likely to have AHT (66.2% vs. 32.3%, P=0.001), no known mechanism of injury (69.1% vs. 32.3%, P=0.015), retinal hemorrhage (75% vs. 35.5%, P=0.002) and hypoxic-ischemic changes (25% vs. 0%, P=0.002). Patients with parasagittal vertex clots have eight times the odds of AHT compared to patients without parasagittal vertex clots. Age-matched control patients who underwent head CT scan due to a history of accidental head injury without SDH were identified (n=87); no patient in the control group had parasagittal vertex clots.ConclusionThe finding of parasagittal vertex clots on CT scans should raise suspicion for abuse and prompt further investigation, especially in the setting of no known, uncertain or inconsistent mechanism of injury.