Abusive head trauma: experience improves diagnosis

  • Purpose: The diagnosis of abusive head trauma (AHT) is complex and neuroimaging plays a crucial role. Our goal was to determine whether non-neuroradiologists with standard neuroradiology knowledge perform as well as neuroradiologists with experience in pediatric neuroimaging in interpreting MRI in cases of presumptive AHT (pAHT). Methods: Twenty children were retrospectively evaluated. Patients had been diagnosed with pAHT (6 patients), non-abusive head trauma-NAHT (5 patients), metabolic diseases (3 patients), and benign enlargement of the subarachnoid spaces (BESS) (6 patients). The MRI was assessed blindly, i.e., no clinical history was given to the 3 non-neuroradiologists and 3 neuroradiologists from 2 different institutions. Results: Blindly, neuroradiologists demonstrated higher levels of sensitivity and positive predictive value in the diagnosis of pAHT (89%) than non-neuroradiologists (50%). Neuroradiologists chose correctly pAHT as the most probable diagnosis 16 out of 18 times; in contrast, non-neuroradiologists only chose 9 out of 18 times. In our series, the foremost important misdiagnosis for pAHT was NAHT (neuroradiologists twice and non-neuroradiologists 5 times). Only victims of motor vehicle accidents were blindly misdiagnosed as pAHT. No usual household NAHT was not misdiagnosed as pAHT. Neuroradiologists correctly ruled out pAHT in all cases of metabolic diseases and BESS. Conclusion: MRI in cases of suspected AHT should be evaluated by neuroradiologists with experience in pediatric neuroimaging. Neuroradiologists looked beyond the subdural hemorrhage (SDH) and were more precise in the assessment of pAHT and its differential diagnosis than non-neuroradiologists were. It seems that non-neuroradiologists mainly assess whether or not a pAHT is present depending on the presence or absence of SDH.

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Author:Luciana PortoORCiDGND, Marco Baz BartelsGND, Jonas ZwaschkaGND, Se-Jong YouGND, Christoph PolkowskiGND, Julian Alexander LuetkensORCiDGND, Christoph Hans-Jürgen EndlerGND, Matthias Kieslich, Elke HattingenORCiDGND
Parent Title (English):Neuroradiology
Place of publication:Berlin ; Heidelberg
Document Type:Article
Date of Publication (online):2020/10/20
Date of first Publication:2020/10/20
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2023/08/03
Tag:Abusive head trauma (AHT); Benign enlargement of the subarachnoid spaces (BESS); Differential diagnosis; Metabolic diseases; Non-abusive head trauma (NAHT)
Page Number:14
First Page:417
Last Page:430
Open Access funding enabled and organized by Projekt DEAL.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International