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peds.abusive-head-trauma.v1

Abusive head trauma / non-accidental trauma in infants

pediatricsacutepediatric
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Encounter flow

12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Confirm AHT differential: history-injury mismatch, multiple injuries different ages, retinal hemorrhages, subdural hematoma without explanation, fractures inconsistent with mechanism (Christian AAP 2009 PMID 19403508)

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Advance rule
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Advance when

AHT considered in differential + multidisciplinary team alerted

Patient inputs (19)

All dosing for hyperosmolar therapy, AED loading, vitamin K weight-based (AAP Red Book 2024-2027, Lexicomp Peds)

Distinguish mobile from non-mobile infant — non-mobile bruises are red flag (Sugar 1999; Christian AAP 2009)

Single parent, partner-of-non-parent, unrelated male caregiver, caregiver-stress factors raise AHT prior (Christian AAP 2009)

Prior CPS involvement OR prior similar events in this infant or siblings raises AHT prior (Christian AAP 2009)

Substance use, intimate partner violence, caregiver mental health, social-isolation features (Christian AAP 2009)

Peak AHT < 6 mo; age < 3 yr is sentinel risk band; mobility status affects bruise interpretation (Christian AAP 2009)

History-injury mismatch is a cardinal AHT feature (Christian AAP 2009)

First-line for acute hemorrhage (Christian AAP 2009)

Detail of subdural, parenchymal injury, axonal injury, cervical-cord injury (Christian AAP 2009)

Complete AP + lateral series at presentation; repeat at 2 weeks for occult metaphyseal lesions (Christian AAP 2009; ACR Appropriateness)

Indirect ophthalmoscopy through dilated pupil by ophthalmology — number / type / pattern / distribution differentiates AHT from other causes (Levin AAP 2010 PMID 20660545)

Anemia from hemorrhage, thrombocytopenia (Christian AAP 2009)

Rule out coagulopathy as alternative explanation (Christian AAP 2009)

AST/ALT elevation flags occult abdominal trauma (Christian AAP 2009)

Severity + airway protection threshold (PALS 2020)

Cushing's triad (HTN + bradycardia) signals ICP crisis (Christian AAP 2009)

Bradycardia in Cushing's triad

Respiratory pattern — apnea / Cheyne-Stokes signals herniation (PALS 2020)

Hemophilia + vWD screen — alternative bleeding diathesis (Christian AAP 2009)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (8)

8 need judgement
  • informationallife_threateningsevere_aht_with_icp_crisis
    AHT with ICP crisis features — GCS drop ≥ 2 points, Cushing's triad (HTN + bradycardia + irregular respiration), posturing, fixed pupil (Christian AAP 2009 PMID 19403508)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereretinal_hemorrhages_pattern_for_aht
    Multilayered, multifocal, extensive retinal hemorrhages extending to periphery on dilated indirect ophthalmoscopy — high specificity for AHT (Levin AAP 2010 PMID 20660545)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverebruising_in_non_mobile_infant
    Bruising in non-mobile infant ("those who don't cruise rarely bruise" Sugar 1999); any bruise in infant < 4 mo or non-cruising infant requires AHT screen (Christian AAP 2009)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveremultiple_fractures_different_ages
    Multiple fractures of different ages OR classic metaphyseal lesions (corner / bucket-handle) OR posterior rib fractures (Christian AAP 2009)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverehistory_injury_mismatch
    Caregiver-reported mechanism inconsistent with injury severity (e.g., "fell off couch" with bilateral subdural + retinal hemorrhages); caregiver gives different stories on separate questioning (Christian AAP 2009)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverepost_traumatic_seizure_in_aht
    Post-traumatic seizure in AHT — immediate impact seizure OR delayed seizure within 7 days; routes to peds.status_epilepticus.v1 if ≥ 5 min OR ≥ 2 without recovery (AES 2016 Glauser PMID 26900382; ICS pediatric TBI consensus)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveresibling_at_risk
    Siblings or other young children in household < 2 yr — must be assessed for AHT injuries during index workup (Christian AAP 2009)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatecoagulopathy_in_aht_workup
    Coagulopathy on baseline labs (INR > 1.5, aPTT prolonged, factor VIII/IX deficient, vWF abnormal) — must be evaluated as alternative explanation BUT cannot exclude AHT (Christian AAP 2009)
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Abusive head trauma — neuroprotective supportive care + ICP rescue + seizure prophylaxis (Christian AAP 2009)
axis: peds_aht_supportive_and_neuroprotective
Selected axis "Abusive head trauma — neuroprotective supportive care + ICP rescue + seizure prophylaxis (Christian AAP 2009)" by default fallback (first axis)
  • PICU admission + neurosurgery consultation + multidisciplinary team
    first line
    critical_care_consultation
    Mandatory for all suspected AHT — PICU + neurosurgery + child-abuse pediatrics + social work + ophthalmology + CPS notification per state law
    triggers: suspected_AHT
    Christian AAP 2009 PMID 19403508 — multidisciplinary team is the foundation; non-pharmacologic and mandatory
  • complete skeletal survey AP + lateral series + repeat at 2 weeks
    first line
    imaging_workup
    Complete AP + lateral series at presentation per ACR Appropriateness; repeat at 2 weeks (occult metaphyseal lesions become visible)
    triggers: suspected_AHT
    Christian AAP 2009 — repeat skeletal survey detects occult / healing fractures not visible at presentation
  • dilated retinal exam by ophthalmology (indirect ophthalmoscopy)
    first line
    ophthalmology_consultation
    Within 24-72 h of presentation by ophthalmology (NOT bedside fundoscopy); document number, type, pattern, distribution (Levin AAP 2010 PMID 20660545)
    triggers: suspected_AHT_or_unexplained_ich_or_brue_under_6mo
    Levin AAP 2010 PMID 20660545 — pattern of retinal hemorrhages differentiates AHT from other causes; bedside fundoscopy inadequate
  • CPS notification per state law + law enforcement notification
    first line
    mandated_reporting
    Mandatory reporting per state law (all 50 states + DC mandate physician reporting of suspected child abuse)
    triggers: suspected_AHT
    Christian AAP 2009 — mandatory reporting protects child + initiates investigation; reasonable suspicion is the threshold, not proof
  • neuroprotective ICU care (HOB 30°, normothermia, normocarbia 35-40 mmHg, target CPP, minimal handling)
    first line
    icu_bundle
    HOB 30°, normothermia (avoid hyperthermia, target T 36.5-37.5°C), normocarbia (PaCO2 35-40), target CPP age-appropriate, minimal handling protocol
    triggers: intubated_AHT_with_ICP_concern
    PALS 2020 + ICS pediatric severe TBI consensus — neuroprotective bundle reduces secondary brain injury
  • mannitol
    rescue
    osmotic_diuretic
    0.25-1 g/kg IV q4-6h PRN for ICP crisis • IV • PRN q4-6h (max: max 4 g/kg/day cumulative)
    triggers: ICP_crisis_or_herniation_features
    ICS pediatric severe TBI consensus — hyperosmolar therapy first-line for ICP crisis; check serum osm + Na before each dose (avoid >320 mOsm; AAP Red Book 2024-2027, Lexicomp Peds)
    rxcui 6628
  • hypertonic saline 3% NaCl
    rescue
    osmotic_agent
    3-5 mL/kg IV bolus over 10-15 min for ICP crisis; may follow with continuous infusion 0.1-1 mL/kg/h titrated to serum Na 145-155 mEq/L • IV • bolus + infusion
    triggers: ICP_crisis_or_herniation_features
    ICS pediatric severe TBI consensus — preferred over mannitol when hypovolemic or hypotensive; weight-based dosing (Lexicomp Peds; AAP Red Book 2024-2027) — listed as non_pharm because 3% NaCl is a compounded concentration not a single RxCUI
  • levetiracetam
    first line
    AED_seizure_prophylaxis
    20-40 mg/kg IV loading dose over 15 min, then 30-60 mg/kg/day divided BID for 7-day post-traumatic seizure prophylaxis • IV/PO • BID after load (max: max 3000 mg per dose, max 60 mg/kg/day per AAP Lexicomp Peds)
    triggers: severe_AHT_or_witnessed_seizure_or_intracranial_blood
    ICS pediatric severe TBI consensus — AED prophylaxis for severe TBI reduces 7-day post-traumatic seizure incidence; levetiracetam preferred over phenytoin (no cardiac monitoring, no enzyme interactions); AVOID valproate < 2 yr (hepatotoxicity) (AAP Red Book 2024-2027, Lexicomp Peds)
    rxcui 114477
  • phytonadione (vitamin K1)
    rescue
    vitamin_K_for_coagulopathy_reversal
    0.3 mg/kg IV/IM/SC slow IV (max 10 mg single dose); for vitamin-K deficiency reversal in suspected hemorrhagic disease of newborn DDx • IV/IM/SC • single dose, may repeat per INR (max: max 10 mg single dose per AAP Red Book 2024-2027 / Lexicomp Peds)
    triggers: suspected_vitamin_K_deficiency_or_INR_elevated_after_birth_with_no_prophylaxis
    Reverses vitamin-K-dependent coagulopathy that mimics AHT (hemorrhagic disease of newborn); use slow IV due to anaphylactoid risk (AAP Red Book 2024-2027, Lexicomp Peds)
    rxcui 8308
  • fresh frozen plasma + cryoprecipitate
    rescue
    blood_product_coagulopathy_reversal
    FFP 10-15 mL/kg IV for INR > 1.5; cryoprecipitate 1 unit/5-10 kg for fibrinogen < 100 • IV • per coagulopathy + bleeding
    triggers: active_bleeding_with_coagulopathy
    AAP transfusion guidance — blood-product reversal for active bleeding + coagulopathy

ed playbook — drug actions (6)

  1. 1. ABC + airway protection if GCS ≤ 8 + IV access
    RSI ketamine + rocuronium preferred for intubation • IV • as needed
    trigger: Severe AHT with GCS ≤ 8 or respiratory compromise
    PALS 2020 — secure airway before transport / imaging if at risk
  2. 2. neurosurgery consultation STAT
    consultation • consult • as needed
    trigger: Acute hemorrhage on CT requiring evacuation OR ICP crisis
    Christian AAP 2009 — evacuable subdural / epidural / parenchymal hemorrhage requires neurosurgery
  3. 3. hypertonic saline 3% NaCl 3-5 mL/kg IV bolus OR mannitol 0.5-1 g/kg IV
    HS 3% 3-5 mL/kg over 10-15 min OR mannitol 0.5-1 g/kg over 20 min • IV • PRN, may repeat
    trigger: ICP crisis (Cushing's triad, GCS drop, posturing, fixed pupil)
    ICS pediatric severe TBI consensus — time-critical for ICP rescue
  4. 4. levetiracetam 20-40 mg/kg IV load
    20-40 mg/kg IV over 15 min (max 3000 mg/dose) • IV • load then BID
    trigger: Severe AHT OR witnessed seizure OR intracranial blood on imaging
    AED prophylaxis for severe pediatric TBI; levetiracetam preferred (no cardiac monitoring)
  5. 5. lorazepam 0.1 mg/kg IV for acute seizure abortive
    0.1 mg/kg IV (max 4 mg) • IV • q5 min x 2
    trigger: Active seizure
    AES 2016 Glauser PMID 26900382 — routes to peds.status_epilepticus.v1 if recurrent
  6. 6. vitamin K 0.3 mg/kg IV slow OR FFP 10-15 mL/kg if coagulopathy and active bleeding
    vitamin K 0.3 mg/kg IV (max 10 mg) slow; FFP 10-15 mL/kg IV • IV • single dose vit K; FFP per coags
    trigger: Coagulopathy reversal for hemorrhagic-disease-of-newborn DDx OR active bleeding
    AAP — vitamin K reverses vitamin K deficiency; FFP for INR > 1.5 with active bleeding

Auto-drafted A&P note

ed

Subjective

- Possible entry pathways: Caregiver-reported "minor fall" or trivial mechanism with severe intracranial injury in an infant < 3 yr (Christian AAP 2009 PMID 19403508); BRUE-like event in infant < 6 mo with no explanation — abusive head trauma differential (Christian AAP 2009); Unexplained subdural hemorrhage or intracranial hemorrhage on CT/MRI in an infant (Christian AAP 2009).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Abusive head trauma / non-accidental trauma in infants** (peds.abusive-head-trauma.v1).
Phenotype framing: AHT vs accidental (mechanism correlates with history); birth-related subdural (resolves by 4 wk typically); hemorrhagic disease of newborn (vitamin K deficiency); glutaric aciduria type 1; osteogenesis imperfecta; benign external hydrocephalus; coagulopathy; accidental scalp injury (Christian AAP 2009)
Scope: Confirm AHT differential: history-injury mismatch, multiple injuries different ages, retinal hemorrhages, subdural hematoma without explanation, fractures inconsistent with mechanism (Christian AAP 2009 PMID 19403508)

No severity triggers fired against current inputs.

Plan

Regimen axis: **Abusive head trauma — neuroprotective supportive care + ICP rescue + seizure prophylaxis (Christian AAP 2009)**.
1. PICU admission + neurosurgery consultation + multidisciplinary team Mandatory for all suspected AHT — PICU + neurosurgery + child-abuse pediatrics + social work + ophthalmology + CPS notification per state law (critical_care_consultation, first line) — Christian AAP 2009 PMID 19403508 — multidisciplinary team is the foundation; non-pharmacologic and mandatory
2. complete skeletal survey AP + lateral series + repeat at 2 weeks Complete AP + lateral series at presentation per ACR Appropriateness; repeat at 2 weeks (occult metaphyseal lesions become visible) (imaging_workup, first line) — Christian AAP 2009 — repeat skeletal survey detects occult / healing fractures not visible at presentation
3. dilated retinal exam by ophthalmology (indirect ophthalmoscopy) Within 24-72 h of presentation by ophthalmology (NOT bedside fundoscopy); document number, type, pattern, distribution (Levin AAP 2010 PMID 20660545) (ophthalmology_consultation, first line) — Levin AAP 2010 PMID 20660545 — pattern of retinal hemorrhages differentiates AHT from other causes; bedside fundoscopy inadequate
4. CPS notification per state law + law enforcement notification Mandatory reporting per state law (all 50 states + DC mandate physician reporting of suspected child abuse) (mandated_reporting, first line) — Christian AAP 2009 — mandatory reporting protects child + initiates investigation; reasonable suspicion is the threshold, not proof
5. neuroprotective ICU care (HOB 30°, normothermia, normocarbia 35-40 mmHg, target CPP, minimal handling) HOB 30°, normothermia (avoid hyperthermia, target T 36.5-37.5°C), normocarbia (PaCO2 35-40), target CPP age-appropriate, minimal handling protocol (icu_bundle, first line) — PALS 2020 + ICS pediatric severe TBI consensus — neuroprotective bundle reduces secondary brain injury
6. mannitol 0.25-1 g/kg IV q4-6h PRN for ICP crisis IV PRN q4-6h (osmotic_diuretic, rescue) — ICS pediatric severe TBI consensus — hyperosmolar therapy first-line for ICP crisis; check serum osm + Na before each dose (avoid >320 mOsm; AAP Red Book 2024-2027, Lexicomp Peds)
7. hypertonic saline 3% NaCl 3-5 mL/kg IV bolus over 10-15 min for ICP crisis; may follow with continuous infusion 0.1-1 mL/kg/h titrated to serum Na 145-155 mEq/L IV bolus + infusion (osmotic_agent, rescue) — ICS pediatric severe TBI consensus — preferred over mannitol when hypovolemic or hypotensive; weight-based dosing (Lexicomp Peds; AAP Red Book 2024-2027) — listed as non_pharm because 3% NaCl is a compounded concentration not a single RxCUI
8. levetiracetam 20-40 mg/kg IV loading dose over 15 min, then 30-60 mg/kg/day divided BID for 7-day post-traumatic seizure prophylaxis IV/PO BID after load (AED_seizure_prophylaxis, first line) — ICS pediatric severe TBI consensus — AED prophylaxis for severe TBI reduces 7-day post-traumatic seizure incidence; levetiracetam preferred over phenytoin (no cardiac monitoring, no enzyme interactions); AVOID valproate < 2 yr (hepatotoxicity) (AAP Red Book 2024-2027, Lexicomp Peds)
9. phytonadione (vitamin K1) 0.3 mg/kg IV/IM/SC slow IV (max 10 mg single dose); for vitamin-K deficiency reversal in suspected hemorrhagic disease of newborn DDx IV/IM/SC single dose, may repeat per INR (vitamin_K_for_coagulopathy_reversal, rescue) — Reverses vitamin-K-dependent coagulopathy that mimics AHT (hemorrhagic disease of newborn); use slow IV due to anaphylactoid risk (AAP Red Book 2024-2027, Lexicomp Peds)
10. fresh frozen plasma + cryoprecipitate FFP 10-15 mL/kg IV for INR > 1.5; cryoprecipitate 1 unit/5-10 kg for fibrinogen < 100 IV per coagulopathy + bleeding (blood_product_coagulopathy_reversal, rescue) — AAP transfusion guidance — blood-product reversal for active bleeding + coagulopathy

Setting playbook (ed) — ABC + neurosurgery + complete AHT workup + CPS notification + multidisciplinary team activation
11. ABC + airway protection if GCS ≤ 8 + IV access RSI ketamine + rocuronium preferred for intubation IV as needed — Severe AHT with GCS ≤ 8 or respiratory compromise (PALS 2020 — secure airway before transport / imaging if at risk)
12. neurosurgery consultation STAT consultation consult as needed — Acute hemorrhage on CT requiring evacuation OR ICP crisis (Christian AAP 2009 — evacuable subdural / epidural / parenchymal hemorrhage requires neurosurgery)
13. hypertonic saline 3% NaCl 3-5 mL/kg IV bolus OR mannitol 0.5-1 g/kg IV HS 3% 3-5 mL/kg over 10-15 min OR mannitol 0.5-1 g/kg over 20 min IV PRN, may repeat — ICP crisis (Cushing's triad, GCS drop, posturing, fixed pupil) (ICS pediatric severe TBI consensus — time-critical for ICP rescue)
14. levetiracetam 20-40 mg/kg IV load 20-40 mg/kg IV over 15 min (max 3000 mg/dose) IV load then BID — Severe AHT OR witnessed seizure OR intracranial blood on imaging (AED prophylaxis for severe pediatric TBI; levetiracetam preferred (no cardiac monitoring))
15. lorazepam 0.1 mg/kg IV for acute seizure abortive 0.1 mg/kg IV (max 4 mg) IV q5 min x 2 — Active seizure (AES 2016 Glauser PMID 26900382 — routes to peds.status_epilepticus.v1 if recurrent)
16. vitamin K 0.3 mg/kg IV slow OR FFP 10-15 mL/kg if coagulopathy and active bleeding vitamin K 0.3 mg/kg IV (max 10 mg) slow; FFP 10-15 mL/kg IV IV single dose vit K; FFP per coags — Coagulopathy reversal for hemorrhagic-disease-of-newborn DDx OR active bleeding (AAP — vitamin K reverses vitamin K deficiency; FFP for INR > 1.5 with active bleeding)

Non-pharmacologic actions:
- PICU consult STAT (Christian AAP 2009)
- Neurosurgery consult STAT (Christian AAP 2009)
- Ophthalmology consult STAT for dilated retinal exam (Levin AAP 2010)
- Child abuse pediatrics consult (Christian AAP 2009)
- Social work consult (Christian AAP 2009)
- CPS notification per state law (Christian AAP 2009)
- Law enforcement notification per state law (Christian AAP 2009)
- Document detailed history with verbatim caregiver statements (Christian AAP 2009)
- Photograph injuries with consent (per state law) (Christian AAP 2009)
- Skeletal survey by pediatric radiology (Christian AAP 2009)
- Separate caregivers for independent histories (Christian AAP 2009)
- Sibling assessment + skeletal survey if siblings < 2 yr (Christian AAP 2009)

AVOID / contraindication checks:
- Do_NOT_discharge_to_suspected_perpetrator_CPS_placement_decision_first (Christian AAP 2009 PMID 19403508)
- Bedside_fundoscopy_inadequate_must_have_dilated_indirect_by_ophthalmology (Levin AAP 2010 PMID 20660545)
- Do_not_omit_repeat_skeletal_survey_at_2_weeks_occult_lesions (Christian AAP 2009)
- Mandatory_CPS_reporting_per_state_law_threshold_is_reasonable_suspicion_not_proof (Christian AAP 2009)
- Mannitol_monitor_serum_osm_avoid_above_320 (Lexicomp Peds)
- Hypertonic_saline_target_serum_Na_145_to_155_avoid_central_pontine_myelinolysis (ICS pediatric TBI)
- Vitamin_K_slow_IV_anaphylactoid_risk (Lexicomp Peds)
- Valproate_avoided_under_2_yr_hepatotoxicity_use_levetiracetam (AAP Red Book 2024 2027)

Monitoring

Regimen monitoring:
- Continuous neuro q1h + GCS + pupils (PALS 2020)
- Continuous cardiac + SpO2 + ETCO2 if intubated (PALS 2020)
- Daily neuro exam (PALS 2020)
- Daily skeletal-survey film review for new lesions (Christian AAP 2009)
- Serial CBC + coags + LFTs (Christian AAP 2009)
- cEEG if intubated + sedated or witnessed seizure (AES 2016 Glauser PMID 26900382)
- Repeat skeletal survey at 2 weeks (Christian AAP 2009)
- Repeat ophthalmologic exam at 1-2 weeks per ophthalmology (Levin AAP 2010)

Setting (ed) monitoring:
- Continuous cardiac + SpO2 + ETCO2 (PALS 2020)
- Continuous neuro q15-30 min initially (PALS 2020)
- Pupil checks q15-30 min (PALS 2020)

Follow-up plan: Pediatric neurology + neurosurgery + ophthalmology (Levin AAP 2010) + developmental pediatrics + early intervention + mental health for sibling cohort + CPS / foster placement coordination + court testimony preparation (Christian AAP 2009)
- Close-out criterion: Follow-up + early intervention + CPS placement documented

Monitoring phase: ICP, neuro q1 h, seizure precautions, cEEG if intubated or sedated, daily neuro exam, social work follow-up, repeat skeletal survey at 2 weeks (Christian AAP 2009; AES 2016)

Disposition

Current setting: ed — ABC + neurosurgery + complete AHT workup + CPS notification + multidisciplinary team activation

Disposition criteria:
- PICU mandatory: GCS ≤ 8, ICP crisis, post-op, intubated, hemodynamic instability, active seizure (Christian AAP 2009)
- Inpatient ward with monitoring: stable post-ED, neurosurgery does not require operative intervention, mild-moderate AHT, complete workup in progress (Christian AAP 2009)
- Discharge: NOT to suspected perpetrator; CPS placement decision required first; safety plan documented; ophthalmology + neurology + developmental peds follow-up arranged (Christian AAP 2009)

Escalation triggers (move to higher acuity):
- GCS drop or new herniation features → hyperosmolar therapy + neurosurgery + PICU (ICS pediatric TBI)
- Active seizure → lorazepam + route to peds.status_epilepticus.v1 (AES 2016 Glauser PMID 26900382)
- Cardiac arrest → PALS resuscitation (PALS 2020)
- Hemodynamic instability → resuscitate + PICU (PALS 2020)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] AHT with ICP crisis features — GCS drop ≥ 2 points, Cushing's triad (HTN + bradycardia + irregular respiration), posturing, fixed pupil (Christian AAP 2009 PMID 19403508)
- [SEVERE] Multilayered, multifocal, extensive retinal hemorrhages extending to periphery on dilated indirect ophthalmoscopy — high specificity for AHT (Levin AAP 2010 PMID 20660545)
- [SEVERE] Bruising in non-mobile infant ("those who don't cruise rarely bruise" Sugar 1999); any bruise in infant < 4 mo or non-cruising infant requires AHT screen (Christian AAP 2009)

Citations

- Christian AAP 2009 PMID 19403508 (abusive head trauma in infants and children) + Levin AAP 2010 PMID 20660545 (eye examination in child abuse) + AES 2016 Glauser PMID 26900382 (status epilepticus cross-reference) + ICS pediatric severe TBI consensus + PALS 2020 [PMID:19403508](https://pubmed.ncbi.nlm.nih.gov/19403508/)
- Cited evidence (PMID 20660545) [PMID:20660545](https://pubmed.ncbi.nlm.nih.gov/20660545/)
- Cited evidence (PMID 26900382) [PMID:26900382](https://pubmed.ncbi.nlm.nih.gov/26900382/)

Last reconciled with current guidelines: 2026-05-26.
References
  • Christian AAP 2009 PMID 19403508 (abusive head trauma in infants and children) + Levin AAP 2010 PMID 20660545 (eye examination in child abuse) + AES 2016 Glauser PMID 26900382 (status epilepticus cross-reference) + ICS pediatric severe TBI consensus + PALS 2020 — PMID:19403508
  • Cited evidence (PMID 20660545) — PMID:20660545
  • Cited evidence (PMID 26900382) — PMID:26900382