Subdural haematoma and effusion
This study took place from March 1998 to February 2000. It aimed to estimate the incidence of fatal and very severe allergic reactions to food in children. To describe the circumstances in which these reactions occurred and describe the clinical course and management of these cases. Additionally, the study wanted to determine whether such children had previous reactions and whether the severity of these previous reactions predicted later severe reactions.
Lead investigator
Dr C Hobbs
About the study
At the time of this study, subdural haematoma/effusion (SDH) was an important cause of death and neurological disability in childhood.
Over half the cases of SDH presented without evidence of skull fracture or other signs of injury to the head. Although the notion of “spontaneous origin” or arising from “minimal trauma” was claimed, an association with severe shaking injury occurring non-accidentally had been firmly established. Despite the evidence linking SDH and shaking injury, cases continued to be encountered where other non-abusive causes were questioned within both medical and legal contexts.
Rare conditions reported to be associated with subdural haemorrhage in childhood included: H. influenzae and pneumococcal meningitis, haemophilia, malignancy, A-V malformation/aneurysm, post cardiopulmonary bypass, glutaric acidaemia, Algelle’s syndrome, disseminated intravascular coagulation, Menke’s disease.
Descriptions of “the shaken baby syndrome” had described clinical findings, including retinal haemorrhages, Subdural and/or
subarachnoid haemorrhage, long bone metaphyseal avulsion and other skeletal injury, including rib fracture and occasional vertebral
injury and little or no evidence of external cranial trauma.
Difficulties in establishing the cause of SDH were more likely to be encountered in cases where there was no other evidence of trauma, including those without retinal haemorrhages – estimated to be about 20 to 50% of cases. Examination of the fundi should have ideally been undertaken by an ophthalmologist who frequently examined children using both direct and indirect ophthalmoscopy in accordance with guidelines (The Ophthalmic Child Abuse. Working Party (D. Taylor, Chairman) Child Abuse and the Eye. Eye 1999; 13:3-10).
This study focused on any child under 2 years of age with fatal and non-fatal subdural haemorrhage, haematoma or hygroma (collection of protein-rich fluid in the subdural space) of any severity, arising from whatever cause and diagnosed on CT, MRI or ultrasound scan or at postmortem examination.
Duration
April 1998 – April 1999
Published papers
Hobbs C, Childs AM, Wynne J, Livingston J, Seal A. Subdural haematoma and effusion in infancy: an epidemiological study. Arch Dis Child. 2005 Sep;90(9):952-5. doi: 10.1136/adc.2003.037739. PMID: 16113132; PMCID: PMC1720567.
BPSU 14th Annual report 1999-2000
Support Group
Children’s Brain Injury Trust
Web: www.childbraininjurytrust.org.uk Email: info@cbituk.org