Aht Diagnoses: The Influences of Clinical Presentation and Evidence of Impact

Authors

• Ruairi Smith-Dewey
• Angela Bachim
• Colleen Bressler
• Kristine Campbell
• Lori Frasier
• Christopher Greeley
• Danielle Horton
• Nicole Johnson
• Jan Leonard
• Megan M Letson
• Caitlin McNamara
• Ashley Sherman
• Shalon Nienow
• Stuart Sommers
• Joanne N Wood
• James Anderst

Language

English

Publication Date

4-1-2026

Journal

Child Abuse & Neglect

DOI

10.1016/j.chiabu.2026.107978

PMID

41791309

PMCID

PMC13093895

PubMedCentral® Posted Date

7-22-2026

PubMedCentral® Full Text Version

Author MSS

Abstract

Background: The frequency of abusive head trauma (AHT) diagnoses by child abuse pediatricians (CAPs), especially regarding external evidence of head impact, has been questioned.

Objectives: To compare CAP diagnoses in subjects with subdural hemorrhage (SDH) across clinical presentations, including subgroups with and without external evidence of head impact. Additionally, we aimed to describe subjects with SDH and concomitant suspicious injuries (CSI) without evidence of head impact.

Participants and setting: Multicenter retrospective study including subjects < 24 months old with SDH.

Methods: Subjects were divided into groups based on clinical presentations: Ill SDH only, Non-ill SDH only, and SDH + CSI. Groups were subcategorized based on presence/absence of external evidence of head impact. AHT diagnoses were compared across groups.

Results: Of the 492 study subjects, 386 (78%) were diagnosed with abuse. Of the 266 subjects without evidence of head impact, 206 (77%) were diagnosed with abuse. In both the total group and the subgroup without evidence of head impact, SDH + CSI subjects were significantly more likely to be diagnosed with abuse than Ill-SDH only and Non-ill SDH only subjects, with odds ratios ranging from 2.6 (95% CI 1.2-5.6) to 10.4 (95% CI 5.0-21.8). Of the 147 SDH + CSI subjects without evidence of head impact, 33% had severe non-retinal injury, such as high specificity and/or multiple fractures or abdominal injury.

Conclusions: In young children with SDH, many of whom are ill and/or have other concerning injuries, CAPs often do not diagnose abuse. Lack of evidence of head impact does not eliminate trauma as a cause of SDH.

Keywords

Humans, Child Abuse, Infant, Retrospective Studies, Female, Male, Hematoma, Subdural, Craniocerebral Trauma, Child, Preschool, Child Abuse, Abusive Head Trauma, Child Abuse Pediatricians, Subdural Hemorrhage, Head Injury

Published Open-Access

yes

Recommended Citation

Smith-Dewey, Ruairi; Bachim, Angela; Bressler, Colleen; et al., "Aht Diagnoses: The Influences of Clinical Presentation and Evidence of Impact" (2026). Faculty, Staff and Students Publications. 7750.
https://digitalcommons.library.tmc.edu/baylor_docs/7750