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Background: Viral meningitis (VM) has been proposed as an alternative cause of subdural hemorrhage (SDH) in young children diagnosed with abusive head trauma (AHT). It has been proposed that VM may mimic symptoms and clinical features of AHT, resulting in an incorrect diagnosis of abuse.
Objective: We aim to evaluate the hypothesis that VM is a mimic of AHT by comparing the history of present illness (HPI) and initial clinical presentation of young children with proven VM to those with subdural hemorrhage and concomitant suspicious injuries (SDH + CSIs) and to those with SDH and no CSIs (SDH only). We hypothesized that significant differences would exist between the VM group and the other two groups.
Design/Methods: We performed a 5-year retrospective case-control study of subjects < 2 years of age comparing those with PCR- confirmed VM (controls) to those with SDH who were evaluated by the hospital Child Abuse Pediatrics (CAP) team (cases). Historical and clinical features were obtained from the Emergency Department and admission notes only. Cases were classified as those with and without one or more CSI. Using Chi-Square test, Fisher’s Exact Test and Mann-Whitney U Test, groups (VM, SDH with CSI, SDH only) were compared across 3 domains: demographics (5 measures), caregiver reported history (20 measures), and clinical (15 measures).
Results: Of 550 subjects, 397 had confirmed VM, 118 had SDH + CSI and 35 had SDH only. The VM subjects differed significantly from SDH + CSI subjects on all demographic measures, and from SDH only subjects on one measure (age). In the history domain, VM subjects differed significantly from SDH + CSI subjects in 18 of 20 measures with odds ratios (ORs) ranging from 2.7 to 322.5. VM subjects differed significantly from SDH only subjects in 12 of the 20 history measures, with ORs ranging from 4.6 to 485.2. In the clinical domain, VM subjects differed significantly from SDH +CSI subjects in 11 of 15 measures, with ORs ranging from 2.5 to 74.0. VM subjects differed significantly from SDH only subjects in 6 of 15 clinical measures with ORs ranging from 2.9 to 16.8. The combined findings of a history of acute mental status change and absence of fever were seen in 62.7% of the SDH + CSI subjects, 45.7% of the SDH only subjects, and 1% of the VM subjects. Using the SDH + CSI group as a proxy for abuse, this combination of features had a positive predictive value (PPV) of 95% for abuse.
Conclusion(s): Viral meningitis is not supported as a mimic of abusive head trauma.
Presented at the 2021 PAS Virtual Conference
Emergency Medicine | Pediatrics | Trauma
Horton, Danielle; Burrell, Tanya; Anderst, James; Hultman, Lyndsey; Moffatt, Mary; Puls, Henry T.; and Selvarangan, Rangaraj, "Evaluation of the hypothesis that viral meningitis is a mimic of abusive head trauma" (2021). Posters. 192.