Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- idade <3 anos
- alteração do estado mental: irritabilidade/letargia/coma
- achados clínicos não condizentes com a história apresentada pelo cuidador
- hemorragia retiniana/vítrea ou retinosquise
- apneia
Other diagnostic factors
- nenhuma história conhecida de trauma
- convulsão
- vômitos
- perda de tônus muscular
- reflexos rápidos ou assimétricos
- hematoma sem explicação
- aumento no perímetro cefálico
- fontanela abaulada
- fraturas em osso longo
- lesão da mucosa ou freios labiais/linguais com rupturas
- sintomas e sinais anogenitais
Risk factors
- idade <1 ano
- pico da curva normal do choro
- cuidador do sexo masculino
- membro adulto e sem parentesco da mesma residência
- sexo masculino
- estressores socioeconômicos
Diagnostic tests
1st tests to order
- TC de crânio
- Hemograma completo
- testes da função hepática
- análise toxicológica
- tempo de protrombina (TP)/TPP ativada/fibrinogênio/teste de von Willebrand
- urinálise
- análise do líquido cefalorraquidiano
- ressonância nuclear magnética (RNM) de crânio
Tests to consider
- ressonância nuclear magnética (RNM) espinhal
- ultrassonografia craniana
- radiografia do esqueleto
- exame de imagem complementar
- hemocultura
- cálcio sérico
- níveis séricos de 1,25-di-hidróxi-vitamina D (calcidiol)
- fósforo inorgânico sérico
- paratormônio (PTH) sérico
- fosfatase alcalina sérica
- biópsia da pele/cultura de fibroblastos
- exame post mortem
Treatment algorithm
todos os pacientes
Contributors
Authors
Barney Scholefield, MBBS, BSc, MSc, MRCPCH, PhD
Consultant in Paediatric Intensive Care
NIHR Clinician Scientist
Birmingham Women’s and Children’s NHS Foundation Trust
Birmingham
UK
Disclosures
BS receives grant funding from the UK NIHR Clinician Scientist Fellowship programme.
Acknowledgements
Dr Barney Scholefield would like to gratefully acknowledge Dr Joe Brierley, Dr Gavin Wooldridge, and Dr Alice Newton, previous contributors to this topic.
Disclosures
JB, GW, and AN declare that they have no competing interests.
Peer reviewers
Amy Goldberg, MD
Attending Physician
Child Protection Team
Hasboro Children's Hospital
Assistant Professor of Pediatrics
Alpert Medical School
Brown University
Providence
RI
Disclosures
AG declares that she has no competing interests.
Rebecca Moles, MD
Division Chief
Child Protection Program
UMass Memorial Medical Center
Worcester
MA
Disclosures
RM declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Narang SK, Fingarson A, Lukefahr J; Council on Child Abuse and Neglect. Abusive head trauma in infants and children. Pediatrics. 2020 Apr;145(4):e20200203.Full text Abstract
Nuño M, Pelissier L, Varshneya K, et al. Outcomes and factors associated with infant abusive head trauma in the US. J Neurosurg Pediatr. 2015 Nov;16(5):515-22.Full text Abstract
National Institute for Health and Care Excellence. Child maltreatment: when to suspect maltreatment in under 18s. October 2017 [internet publication].Full text
Piteau SJ, Ward MG, Barrowman NJ, et al. Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics. 2012 Aug;130(2):315-23. Abstract
Christian CW, Levin AV, Committee on Child Abuse and Neglect, et al. The eye examination in the evaluation of child abuse. Pediatrics. 2018 Aug;142(2):e20181411.Full text Abstract
American College of Radiology. Practice parameters for the performance andinterpretation of skeletal surveys in children. 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Trauma cranioencefálico acidental
- Trauma de nascimento
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