Most young children with intracranial hemorrhage should have skeletal survey

By Reuters Staff

NEW YORK - Nearly all children younger than 24 months of age who present with intracranial hemorrhage (ICH) should undergo evaluation with skeletal survey for additional injuries concerning for abuse, according to new clinical guidelines.

The American Academy of Pediatrics (AAP) recommends evaluating for occult fractures in all children <2 years old who are suspected victims of physical abuse, but more specific guidelines on which young children with head trauma should undergo skeletal survey (SS) are not available.

Christine Weirich Paine from Children's Hospital of Philadelphia, Pennsylvania, and colleagues used the RAND/UCLA Appropriateness Method to identify clinical scenarios where SS is appropriate and where SS is unnecessary for children <2 years old with ICH.

In their March 8 Pediatrics online report, the team identified four conditions in which SS would be indicated:

* children presenting with an extra-axial brain hemorrhage from reported abuse or intimate partner violence or presenting with additional injuries unrelated to the ICH.

* asymptomatic children with a tiny extra-axial hemorrhage directly under a skull fracture, except for infants 6 to 11 months old with a history of a fall from at least three feet.

* all children presenting with subdural hemorrhage, regardless of presentation or history.

* all children presenting with epidural hemorrhage, except for clinically well infants 6 to 11 months old with a history of a fall from at least three feet and toddlers 12 to 23 months old with a history of a fall from at least three feet or a crush injury.

"The resulting clinical guidelines call for near-universal evaluation in children <24 months old presenting with ICH," the authors conclude. "Detailed, validated guidelines that are successfully implemented may decrease variation and disparities in care."

Paine did not respond to a request for comments.

The National Institutes of Health funded this research. The authors made no disclosures.

SOURCE: http://bit.ly/1QIcEvw

Pediatrics 2016.

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