{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:20:20Z","timestamp":1792660820086,"version":"4.5.0"},"reference-count":24,"publisher":"BMJ","issue":"7172","license":[{"start":{"date-parts":[[1998,12,5]],"date-time":"1998-12-05T00:00:00Z","timestamp":912816000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1998,12,5]]},"abstract":"<jats:p>\n                    <jats:bold>Objectives:<\/jats:bold>\n                    To identify the incidence, clinical outcome, and associated factors of subdural haemorrhage in children under 2 years of age, and to determine how such cases were investigated and how many were due to child abuse.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design:<\/jats:bold>\n                    Population based case series.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting:<\/jats:bold>\n                    South Wales and south west England.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Subjects:<\/jats:bold>\n                    Children under 2 years of age who had a subdural haemorrhage. We excluded neonates who developed subdural haemorrhage during their stay on a neonatal unit and infants who developed a subdural haemorrhage after infection or neurosurgical intervention.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures:<\/jats:bold>\n                    Incidence and clinical outcome of subdural haemorrhage in infants, the number of cases caused by child abuse, the investigations such children received, and associated risk factors.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Thirty three children (23 boys and 10 girls) were identified with subdural haemorrhage. The incidence was 12.8\/100 000 children\/year (95% confidence interval 5.4 to 20.2). Twenty eight cases (85%) were under 1 year of age. The incidence of subdural haemorrhage in children under 1 year of age was 21.0\/100 000 children\/year and was therefore higher than in the older children. The clinical outcome was poor: nine infants died and 15 had profound disability. Only 22 infants had the basic investigations of a full blood count, coagulation screen, computed tomography or magnetic resonance imaging, skeletal survey or bone scan, and ophthalmological examination. In retrospect, 27 cases (82%) were highly suggestive of abuse.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Subdural haemorrhage is common in infancy and carries a poor prognosis; three quarters of such infants die or have profound disability. Most cases are due to child abuse, but in a few the cause is unknown. Some children with subdural haemorrhage do not undergo appropriate investigations. We believe the clinical investigation of such children should include a full multidisciplinary social assessment, an ophthalmic examination, a skeletal survey supplemented with a bone scan or a skeletal survey repeated at around 10 days, a coagulation screen, and computed tomography or magentic resonance imaging. Previous physical abuse in an infant is a significant risk factor for subdural haemorrhage and must be taken seriously by child protection agencies.\n                  <\/jats:p>","DOI":"10.1136\/bmj.317.7172.1558","type":"journal-article","created":{"date-parts":[[2011,10,27]],"date-time":"2011-10-27T19:55:56Z","timestamp":1319745356000},"page":"1558-1561","source":"Crossref","is-referenced-by-count":235,"title":["Subdural haemorrhages in infants: population based study"],"prefix":"10.1136","volume":"317","author":[{"given":"S","family":"Jayawant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Rawlinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Gibbon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Price","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Schulte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Sharples","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J R","family":"Sibert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A M","family":"Kemp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1998,12,5]]},"reference":[{"key":"2025122508585542000_317.7172.1558.1","first-page":"361","article-title":"Etude medico-legale sur les services et mauvais traitements exerces sur des enfants.","volume":"13","author":"Tardieu","year":"1860","journal-title":"Ann Hyg Publ Med Leg"},{"key":"2025122508585542000_317.7172.1558.2","first-page":"163","article-title":"Multiple fractures of long bones of children suffering from subdural haematoma.","volume":"56","author":"Caffey","year":"1946","journal-title":"Am J Roentgenology"},{"key":"2025122508585542000_317.7172.1558.3","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1542\/peds.75.2.340","article-title":"Serious head injury in infants: accident or abuse.","volume":"75","author":"Billmire","year":"1985","journal-title":"Paediatrics"},{"key":"2025122508585542000_317.7172.1558.4","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1136\/bmj.310.6976.344","article-title":"The shaken infant syndrome.","volume":"310","author":"Carty","year":"1995","journal-title":"BMJ"},{"key":"2025122508585542000_317.7172.1558.5","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1136\/adc.76.5.393","article-title":"Head injury\u2014abuse or accident.","volume":"76","author":"Wilkins","year":"1997","journal-title":"Arch Dis Child"},{"key":"2025122508585542000_317.7172.1558.6","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1227\/00006123-198904000-00008","article-title":"The infant whiplash shake injury syndrome: a clinical and pathological study.","volume":"24","author":"Hadley","year":"1989","journal-title":"Neurosurgery"},{"key":"2025122508585542000_317.7172.1558.7","unstructured":"Office for National Statistics. London:HMSO,1993-5."},{"key":"2025122508585542000_317.7172.1558.8","unstructured":"Department of Health .Confidential enquiry into stillbirths and deaths in infancy (CESDI). Third annual report. London:Department of Health,1996."},{"key":"2025122508585542000_317.7172.1558.9","unstructured":"British Paediatric Surveillance Unit .Sixth annual report. London:British Paediatric Association,1991."},{"key":"2025122508585542000_317.7172.1558.10","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/S0196-0644(84)80571-5","article-title":"Shaken baby syndrome. A review of 20 cases.","volume":"13","author":"Ludwig","year":"1984","journal-title":"Ann Emerg Med"},{"key":"2025122508585542000_317.7172.1558.11","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1542\/peds.92.6.872","article-title":"American Academy of Pediatrics. Shaken infant syndrome: inflicted cerebral trauma.","volume":"92","year":"1993","journal-title":"Paediatrics"},{"key":"2025122508585542000_317.7172.1558.12","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1111\/j.1469-8749.1995.tb11949.x","article-title":"Outcome and prognosis of whiplash shaken infant syndrome; late consequences after a symptom-free intervals.","volume":"37","author":"Bonnier","year":"1995","journal-title":"Dev Med Child Neurol"},{"key":"2025122508585542000_317.7172.1558.13","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1972.02110140011001"},{"key":"2025122508585542000_317.7172.1558.14","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1111\/j.1469-8749.1993.tb11563.x","article-title":"Non-accidental head injury with particular reference to whiplash shaking injury and medico-legal aspects.","volume":"35","author":"Brown","year":"1993","journal-title":"Dev Med Child Neurol"},{"key":"2025122508585542000_317.7172.1558.15","doi-asserted-by":"publisher","DOI":"10.1016\/0145-2134(92)90004-B"},{"key":"2025122508585542000_317.7172.1558.16","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1136\/bmj.2.5759.430","article-title":"Infantile subdural haematoma and its relationship to whiplash injuries.","volume":"ii","author":"Guthkelch","year":"1971","journal-title":"BMJ"},{"key":"2025122508585542000_317.7172.1558.17","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1990.02150250068033"},{"key":"2025122508585542000_317.7172.1558.18","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1542\/peds.90.2.179","article-title":"Head injury in very young children: mechanism, injury types and ophthalmologic findings in 100 hospitalised patients younger than 2 years of age.","volume":"20","author":"Duhaime","year":"1992","journal-title":"Paediatrics"},{"key":"2025122508585542000_317.7172.1558.19","first-page":"42","article-title":"What can cause subdural haemorrhage in a term infant?","volume":"5","author":"Salman","year":"1997","journal-title":"Paediatr Today"},{"key":"2025122508585542000_317.7172.1558.20","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1542\/peds.87.2.262","article-title":"Diagnostic imaging of child abuse.","volume":"87","author":"Haller","year":"1991","journal-title":"Pediatrics"},{"key":"2025122508585542000_317.7172.1558.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(86)80279-7"},{"key":"2025122508585542000_317.7172.1558.22","doi-asserted-by":"publisher","DOI":"10.1136\/adc.59.9.860"},{"key":"2025122508585542000_317.7172.1558.23","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.80.4.282"},{"key":"2025122508585542000_317.7172.1558.24","doi-asserted-by":"publisher","DOI":"10.1016\/0039-6257(92)90002-B"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.317.7172.1558","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.317.7172.1558","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T16:59:03Z","timestamp":1766681943000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.317.7172.1558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1998,12,5]]},"references-count":24,"journal-issue":{"issue":"7172","published-online":{"date-parts":[[1998,12,5]]},"published-print":{"date-parts":[[1998,12,5]]}},"alternative-id":["10.1136\/bmj.317.7172.1558"],"URL":"https:\/\/doi.org\/10.1136\/bmj.317.7172.1558","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1998,12,5]]}}}