Although seen from birth through adolescence, this diagnosis is most common in children under 3 years of age. Evaluation of a child for head injury outside the setting of a well-documented motor vehicle or other accident must include consideration of nonaccidental trauma. Unless a plausible mechanism of injury is appropriately described and independently verified by any involved adults, further investigation is warranted.
A thorough physical examination should be undertaken to detect bruises, burns, abnormalities in the bone and other evidence of previous injuries. A skeletal X-ray survey should be obtained to document any previous fractures. Opthalmalogical examination should be ordered to look for retinal hemorrhages, which are a sign of acceleration-deceleration injuries (i.e., 'shaking-impact syndrome').
Investigation of possible nonaccidental trauma should be carried out by a child-abuse evaluation team. Both federal and state laws mandate medical and other professionals in contact with injured children to report possible nonaccidental trauma to legal authorities and/or to obtain consultation from a registered child-abuse evaluation team. Civil liability for failure to diagnose and/or report child abuse also pertains to practicing neurosurgeons.
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