{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:13Z","timestamp":1789711753134,"version":"4.0.1"},"reference-count":9,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,7,1]]},"abstract":"<jats:p>Objective. To describe the clinical features that distinguish accidental from abusive head injury in hospitalized children &amp;lt;24 months of age.<\/jats:p><jats:p>Methods. Prospective study of children &amp;lt;24 months of age hospitalized for head injury between August 1, 2000, and October 31, 2002. During hospitalization, children had computed tomographic scans of the brain, serial neurologic examinations, dilated ophthalmoscopic eye examinations, evaluation by a social worker, and, in some cases, a child abuse specialist.<\/jats:p><jats:p>Outcome Measures. The main outcome measure was the proportion of children in each group with retinal hemorrhages (RHs). Secondary outcome measures were the proportion of children in each group who had vitreous hemorrhage; abnormal mental status on presentation; seizures; scalp hematomas; need for anticonvulsants; and operative procedures such as subdural tap, craniotomy, ventriculostomy, tracheostomy, and gastrostomy.<\/jats:p><jats:p>Results. Eighty-seven children were prospectively enrolled. Fifteen children were classified as having abusive head injury, and 72 were classified as having accidental head injury. Five children, all in the accidental head injury group, were excluded from statistical analysis, because they did not have a dilated ophthalmoscopic examination during their hospitalization. Thus 82 children were included in the statistical analysis. There were no significant differences between the 2 groups with respect to mean age, gender, or ethnicity. RHs were more likely to be seen in children with abusive head injury (60% vs 10%) and were more likely to be bilateral (40% vs 1.5%). Pre-RHs were more likely to be seen in children with abusive head injury (30% vs 0%). Premacular RHs and RHs that extended to the periphery of the retina were also more likely to be seen in children with abusive head injury (20% vs 0% and 27% vs 0%, respectively). Of the 7 children with accidental head injury who had RHs, 6 had unilateral RHs. Children with abusive head injury were more likely to have seizures (53% vs 6%) and an abnormal mental status on initial presentation (53% vs 1%). Children with accidental head injury were more likely to have scalp hematomas (6.7% vs 49%).<\/jats:p><jats:p>Conclusions. RHs are seen more often in abusive head injury and often are bilateral and involve the preretinal layer. Children with abusive head injury were more likely to have RHs that cover the macula and extend to the periphery of the retina. Unilateral RHs can be seen in children with accidental head injury. Children with abusive head injury were more likely to present with abnormal mental status and seizures, whereas children with accidental head injury were more likely to have scalp hematomas. Such characteristics may be useful to distinguish accidental from abusive head trauma in children &amp;lt;24 months of age.<\/jats:p>","DOI":"10.1542\/peds.114.1.165","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"165-168","source":"Crossref","is-referenced-by-count":215,"title":["Characteristics That Distinguish Accidental From Abusive Injury in Hospitalized Young Children With Head Trauma"],"prefix":"10.1542","volume":"114","author":[{"given":"Kirsten","family":"Bechtel","sequence":"first","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Stoessel","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Leventhal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Ogle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Teague","sequence":"additional","affiliation":[{"name":"Children\u2019s Clinical Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Lavietes","sequence":"additional","affiliation":[{"name":"Department of Social Work, Yale New Haven Children\u2019s Hospital, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna","family":"Banyas","sequence":"additional","affiliation":[{"name":"Children\u2019s Clinical Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Allen","sequence":"additional","affiliation":[{"name":"Children\u2019s Clinical Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Dziura","sequence":"additional","affiliation":[{"name":"Children\u2019s Clinical Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Duncan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2004,7,1]]},"reference":[{"key":"2021121006510778500_R1","doi-asserted-by":"crossref","unstructured":"Duhaime AC, Christian CW, Rorke LR, Zimmerman RA. Nonaccidental head trauma in infants\u2014the \u201cshaken baby syndrome.\u201d N Engl J Med.\u20081999;338:1822\u20131829","DOI":"10.1056\/NEJM199806183382507"},{"key":"2021121006510778500_R2","doi-asserted-by":"crossref","unstructured":"Duhaime AC, Christian C, Moss E, Seidl T. Long-term outcome in infants with the shaking-impact syndrome. Pediatr Neurosurg.\u20081996;24:292\u2013298","DOI":"10.1159\/000121058"},{"key":"2021121006510778500_R3","doi-asserted-by":"crossref","unstructured":"Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA. 1999;281:621\u2013626","DOI":"10.1001\/jama.281.7.621"},{"key":"2021121006510778500_R4","doi-asserted-by":"crossref","unstructured":"Duhaime AC, Alario AJ, Lewander WJ, et al. Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics. 1992;90:179\u2013185","DOI":"10.1542\/peds.90.2.179"},{"key":"2021121006510778500_R5","unstructured":"Reece RM, Sege R. Childhood head injuries: accidental or inflicted?Arch Pediatr Adolesc Med.\u20082000;154:11\u201315"},{"key":"2021121006510778500_R6","doi-asserted-by":"crossref","unstructured":"Morad Y, Kim YM, Mian M, Huyer D, Capra L, Levin AV. Nonophthalmologist accuracy in diagnosing retinal hemorrhages in the shaken baby syndrome. J Pediatr.\u20082003;142:431\u2013434","DOI":"10.1067\/mpd.2003.161"},{"key":"2021121006510778500_R7","doi-asserted-by":"crossref","unstructured":"Johnson DL, Braun D, Friendly D. Accidental head trauma and retinal hemorrhage. Neurosurgery. 1993;33:231\u2013234","DOI":"10.1227\/00006123-199308000-00008"},{"key":"2021121006510778500_R8","doi-asserted-by":"crossref","unstructured":"Christian CW, Taylor AA, Hertle RW, Duhaime AC. Retinal hemorrhages caused by accidental household trauma. J Pediatr.\u20081999;135:125\u2013127","DOI":"10.1016\/S0022-3476(99)70343-4"},{"key":"2021121006510778500_R9","doi-asserted-by":"crossref","unstructured":"Schloff S, Mullaney PB, Armstrong DC, et al. Retinal findings in children with intracranial hemorrhage. Ophthalmology. 2002;109:1472\u20131476","DOI":"10.1016\/S0161-6420(02)01086-2"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/1\/165\/1005852\/zpe00704000165.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/1\/165\/1005852\/zpe00704000165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:36:31Z","timestamp":1682746591000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/114\/1\/165\/64787\/Characteristics-That-Distinguish-Accidental-From"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,7,1]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2004,7,1]]},"published-print":{"date-parts":[[2004,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.114.1.165","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,7,1]]}}}