Abusive head trauma: experience improves diagnosis
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PAEDIATRIC NEURORADIOLOGY
Abusive head trauma: experience improves diagnosis Luciana Porto 1 & Marco Baz Bartels 2 & Jonas Zwaschka 1 & Se-Jong You 1 & Christoph Polkowski 1 & Julian Luetkens 3 & Christoph Endler 3 & Matthias Kieslich 2 & Elke Hattingen 1 Received: 25 May 2020 / Accepted: 31 August 2020 # The Author(s) 2020
Abstract Purpose The diagnosis of abusive head trauma (AHT) is complex and neuroimaging plays a crucial role. Our goal was to determine whether non-neuroradiologists with standard neuroradiology knowledge perform as well as neuroradiologists with experience in pediatric neuroimaging in interpreting MRI in cases of presumptive AHT (pAHT). Methods Twenty children were retrospectively evaluated. Patients had been diagnosed with pAHT (6 patients), non-abusive head trauma-NAHT (5 patients), metabolic diseases (3 patients), and benign enlargement of the subarachnoid spaces (BESS) (6 patients). The MRI was assessed blindly, i.e., no clinical history was given to the 3 non-neuroradiologists and 3 neuroradiologists from 2 different institutions. Results Blindly, neuroradiologists demonstrated higher levels of sensitivity and positive predictive value in the diagnosis of pAHT (89%) than non-neuroradiologists (50%). Neuroradiologists chose correctly pAHT as the most probable diagnosis 16 out of 18 times; in contrast, non-neuroradiologists only chose 9 out of 18 times. In our series, the foremost important misdiagnosis for pAHT was NAHT (neuroradiologists twice and non-neuroradiologists 5 times). Only victims of motor vehicle accidents were blindly misdiagnosed as pAHT. No usual household NAHT was not misdiagnosed as pAHT. Neuroradiologists correctly ruled out pAHT in all cases of metabolic diseases and BESS. Conclusion MRI in cases of suspected AHT should be evaluated by neuroradiologists with experience in pediatric neuroimaging. Neuroradiologists looked beyond the subdural hemorrhage (SDH) and were more precise in the assessment of pAHT and its differential diagnosis than non-neuroradiologists were. It seems that non-neuroradiologists mainly assess whether or not a pAHT is present depending on the presence or absence of SDH. Keywords Abusive head trauma (AHT) . Non-abusive head trauma (NAHT) . Benign enlargement of the subarachnoid spaces (BESS) . Metabolic diseases . Differential diagnosis
Introduction The published review of the literature on “abusive head trauma” (AHT) in infants by the Swedish Agency for Health LP and MBB Divided First Authorship * Luciana Porto [email protected] 1
Institute of Neuroradiology, Hospital of Goethe University, University Hospital Frankfurt, Schleusenweg 2 – 16, 60528 Frankfurt am Main, Germany
2
Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt am Main, Germany
3
Institute of Neuroradiology, University Hospital Bonn, Bonn, Germany
Technology and Assessment of Social Services (SBU) [1] triggered an intense discussion on this issue. The main conclusion of the report was that there is insufficient scientific evidence on which to asses
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