Introduction: The aim of this study was to review our ten year single institutional experience with NAHT to identify the cumulative incidence of post – traumatic ventriculomegaly (PTV), whether this was associated with patients who underwent a decompressive craniectomy (DC), and whether this necessitated a permanent shunt.

Methods: A prospective registry was collected for patients evaluated by child protective services. We retrospectively reviewed patients diagnosed with NAHT between the years of 1998–2009 and examined only those patients in which the perpetrator was specifically identified. Admission delay was classified into three categories: no (0-6 hours), moderate (6-12 hours), and severe delay (x>12 hours). Discharge outcomes were assessed using the KOSCHI scale. CTs were reviewed by a neuroradiologist and neurosurgeon blinded to the study.

Results: Age ranged from 2 to 34 months. Nineteen (68%) patients were male, while most perpetrators were female. Initial examination revealed a delay (moderate and severe delay) in child arrival to the hospital in a majority (17/28; 61%) of patients. A low arrival GCS (p<0.0001) and associated extracranial injuries (p<0.0061) correlated with lower outcomes. Incidence of PTV was identified in 39% (11/28) of patients; six whom underwent decompression (PTV/DC 4/6; 67%) and seven of whom did not (PTV/noDC 7/22; 32%). A low arrival GCS score demonstrated early PTV presentation (x<3days) versus a mild-moderate GCS score (x>1wk). Earlier PTV appearance and worse outcomes were identified in those classified with moderate delay. A majority of PTV-NAHT patients presented with a SDH (convexity/interhemispheric) and ischemic stroke. Two patients (2/28; 7%) developed hydrocephalus requiring a permanent shunt (without DC), however one patient required a VPS after a limited temporal DC (1/6; 17%). DC were performed with a superior limit x>25mm away from the superior sagittal sinus.

Conclusions: Few PTV - NAHT patients develop shunt dependant hydrocephalus.

Patient Care: Findings here will attempt to identify epidemiologic characteristics and the underlying mechanism towards understanding and surgically treating hydrocephalus in childhood victims of non-accidental trauma.

Learning Objectives: 1. To identify the incidence of post - traumatic ventriculomegaly and hydrocephalus in NAHT patients. 2. To understand the role of cranial decompression on hydrocephalus in NAHT patients.

References: 1. Duhaime AC et al. N Engl J Med 338:1822–1829, 1998 2. Ruppel RA, Kochanek PM, Adelson PD et al. J Pediatr. 138:18-25, 2001.