What's Your Diagnosis? Nonaccidental Trauma in Pediatric Patients

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Emergency Department Management of Children With Macrocephaly right.

Case Presentation: Emergency Department Evaluation and Management of Nonaccidental Trauma in Pediatric Patients

A 2-month-old boy is brought to the ED by his mother for lethargy and a seizure at home…

The mother states that earlier that day the child had been fussier than usual, then he had a seizure lasting about 3 minutes. Since the seizure, the child has been very sleepy.

The boy’s temperature and vital signs are normal. On examination, the infant appears lethargic, with poor tone. He vomits once in the ED.

What is on your differential for this patient? What are the next steps in management?

Case Conclusion

Given the new-onset seizure and lethargy, a CT scan and bloodwork were ordered. The bloodwork returned within normal limits. The CT showed bilateral subdural hemorrhages. A retinal examination was performed, which showed retinal hemorrhages. Social work, neurosurgery, and Child Protective Services were alerted. The child was admitted to the pediatric intensive care unit for further management.