Nonaccidental head trauma as a cause of childhood death.

[child syndrome]

The authors present the demographic and clinical information in 36 children who died as a result of abusive head trauma at a Level 1 pediatric trauma center between January 1 , 1997 , and January 1 , 2004 .Abusive head trauma was defined as radiographic evidence of intracranial injury and documentation from a multidisciplinary child protection team that the injury was nonaccidental . There was no sex bias for the children in the 1 st year of life (nine girls , nine boys ). In children older than 1 year of age , boys were much more likely to be victims (14 boys , four girls ). At the time of admission , every child exhibited a seriously impaired level of consciousness and 81 % had retinal hemorrhages . Injuries to other organ systems were rare (17 %). The most common abnormality found on neuroimaging studies was subdural hematoma . Six children underwent craniotomy for extraaxial hematomas . Death occurred within 24 hours after hospital admission in one half of the cases .Abusive head trauma was the cause of death in 36 (86 %) of the 42 children whose deaths were classified as nonaccidental at the Children 's Hospital in Denver between 1997 and 2003 . The authors were unable to identify anything that could have been done from a medical or neurosurgical viewpoint to prevent the deaths of these children after they came to medical attention .