Intracranial Injuries in Asymptomatic Infants Undergoing Subspecialty Evaluation for Physical Abuse: A Multicenter Study.

Creator(s)

• M Katherine Henry
• Rachel P. Berger
• Chris Feudtner
• Daniel M. Lindberg
• Kristine A. Campbell
• Jing Huang
• James Anderst, Children's Mercy HospitalFollow
• Angela N. Bachim
• Farah W. Brink
• Lori D. Frasier
• Nancy S. Harper
• Natalie Laub
• John D. Melville
• Jenna Kiely
• Stuart W. Sommers
• Porcia Vaughn
• Jan Leonard
• Joanne N. Wood

Document Type

Article

Publication Date

5-2026

Identifier

DOI: 10.1016/j.acap.2026.103294

Abstract

OBJECTIVE: The reported prevalence of intracranial injuries (ICI) in asymptomatic infants undergoing physical abuse evaluations varies widely. To inform neuroimaging decisions, we sought to 1) describe ICI prevalence among asymptomatic infants evaluated for abuse, 2) assess the impact of different definitions of "asymptomatic" on ICI prevalence across different age groups, and 3) assess whether hospital-level neuroimaging rates impact prevalence of identified ICI.

METHODS: We conducted a cross-sectional study of infants < 12 months without seizures or altered mental status (AMS) undergoing subspecialty evaluations for physical abuse from February 2021 through December 2022 within CAPNET, a multicenter child abuse research network. We report ICI prevalence among infants without seizures or AMS and across 3 subpopulations with progressively stricter definitions of "asymptomatic."

RESULTS: Of 1947 infants without seizures or AMS, 1513 (77.7%) underwent neuroimaging. Of these infants, 13.7% had ICI. After excluding infants with signs of blunt head injury, ICI prevalence decreased to 5.4%. After additionally excluding infants with neurologic signs or symptoms, ICI prevalence was 5.0%. With additional exclusion of infants with nonspecific symptoms, ICI prevalence was 4.7%.

CONCLUSIONS: ICI prevalence in asymptomatic infants depends upon the definition of "asymptomatic". When strictly defined, asymptomatic ICI occurs in approximately 1 in 21 infants undergoing evaluations for abuse. Among infants without signs of blunt head trauma, infants < 6 months have a higher risk of ICI compared to older infants.

Journal Title

Acad Pediatr

Volume

26

Issue

4

First Page

103294

Last Page

103294

MeSH Keywords

Humans; Infant; Cross-Sectional Studies; Child Abuse; Male; Female; Prevalence; Neuroimaging; Infant, Newborn; Craniocerebral Trauma

PubMed ID

41839328

Keywords

CAPNET; abusive head trauma; child physical abuse; diagnostic imaging; occult head trauma

Recommended Citation

Henry MK, Berger RP, Feudtner C, et al. Intracranial Injuries in Asymptomatic Infants Undergoing Subspecialty Evaluation for Physical Abuse: A Multicenter Study. Acad Pediatr. 2026;26(4):103294. doi:10.1016/j.acap.2026.103294