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Infant Head Injury in Falls and Nonaccidental Trauma: Does Injury Pattern Correlate With Mechanism?

Pontarelli, Elizabeth M. MD*; Jensen, Aaron R. MD, MEd*; Komlofske, Kari M. FNP; Bliss, David W. MD*†

doi: 10.1097/PEC.0000000000000226
Original Articles

Objectives Nonaccidental trauma (NAT) is most common and most lethal in infants. Falls are the most frequently given explanation for NAT, and head injuries can result from both mechanisms. We hypothesized that infant head injuries from NAT have a distinct injury profile compared to falls.

Methods The trauma registry and patient records were reviewed from 2004 to 2008. Infants with at least 1 head computed tomography were included.

Results Ninety-nine infants were identified. Falls (67 patients) and NAT (21 patients) were the most common mechanism of injury. Falls had lower injury severity scores, 5 versus 17 compared to NAT (P < 0.001). Nonaccidental trauma patients had injuries to face, chest, abdomen, or extremities much more frequently, 62% versus 3% in falls (P < 0.001). Isolated intracranial hemorrhage was higher in NAT (60% vs. 23%, P = 0.002), whereas isolated skull fracture was higher in falls (42% vs. 5%, P = 0.005). Outcomes for NAT showed longer intensive care unit stays (4 days vs. 1 day; P < 0.001), longer hospital stays (7 days vs. 1 day; P < 0.001), and more intracranial operations (9 vs. 1; P < 0.001).

Conclusions We recommend that all children younger than 1 year, with an isolated intracranial hemorrhage, have a full NAT work-up. Injury severity score greater than 20, Glasgow Coma Scale less than 13, and extracranial injuries should also increase suspicion of NAT.

From the *Children’s Hospital Los Angeles, Los Angeles, CA and †Randall Children’s Hospital, Portland, OR.

Disclosure: The authors declare no conflict of interest.

Reprints: Elizabeth M. Pontarelli, MD, Children’s Hospital Los Angeles, 4650 W. Sunset Blvd, Mailstop 100, Los Angeles, CA 90027 (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.