Spinal Bleeding from Child Abuse Finding Supports Need for Complete Spine Imaging

Spinal bleeding is a hallmark for child abuse, so complete spine imaging should be performed for young children undergoing brain magnetic resonance imaging for moderate or severe traumatic brain injury, according to a study published online Nov. 8 in the journal Radiology.

Spine imaging may be a way to distinguish between abusive and accidental injury, as well, said lead author Arabinda Kumar Choudhary, MD, a pediatric radiologist at Penn State University.

Abusive head trauma is the leading cause of significant traumatic brain injury in infants, with a 20 percent to 38 percent mortality rate and significant neurological and developmental impairment in 30 percent to 78 percent of survivors, according to the study. Spinal injuries such as spinal subdural hemorrhage - bleeding in the space between the spinal cord and its tough outer membrane - can be overshadowed by brain injury and traumatic coma and therefore overlooked during diagnosis, the researchers said.

To study the incidence of spinal subdural hemorrhage, Choudhary and colleagues looked at clinical data and imaging records for 252 children aged two years old or younger who underwent treatment for abusive head trauma at the medical center. Imaging results included computed tomography (CT) and MRI of the brain, spine, chest, abdomen and pelvis. They compared the imaging results to those from a group of 70 similarly aged children who were treated for accidental trauma.

Spinal canal subdural hemorrhage was evident in more than 60 percent of the children with abusive head trauma who underwent whole-spine imaging. In contrast, spinal canal subdural hemorrhage was rare in accidental trauma. Only one of the 70 children in the accidental trauma group had spinal subdural hemorrhage.

Choudhary said imaging the spine is in cases of suspected abuse is important for two reasons.

“Most of the spinal injuries in abusive head trauma are clinically silent because of extensive injuries elsewhere and lack of a clinical history suggestive of spinal injury. It is important to rule out any significant injury to the spine and spinal cord,” he said. “Also, spine imaging allows complications of subdural hemorrhage collecting in the spinal canal to be diagnosed earlier."