Occasionally, during our morning report, a young patient with acute neurologic symptoms is discussed. When the differential diagnosis is discussed, invariably meningitis and non-accidental trauma are included.
Some say symptoms of viral meningitis often mimic those of abusive head trauma in young children. Is that really true? This week, Pediatrics is early releasing an article, entitled “Differences between Viral Meningitis and Abusive Head Trauma,” by Dr. Danielle Horton and her colleagues at Children’s Mercy Kansas City and the University of Missouri-Kansas City, that seeks to answer this question (10.1542/peds.2021-054544).
The authors conducted a retrospective case-control study of 550 children <2 years of age. The controls were children with a diagnosis of viral meningitis, confirmed by nucleic acid amplification test of cerebrospinal fluid. The cases were children who had confirmed subdural hemorrhage, with or without concomitant suspicious injuries, and who were included in the hospital’s Child Abuse Pediatrics database. The authors then compared the demographic characteristics, history of present illness (HPI), and clinical characteristics for cases and controls.
Were the presentations of patients with viral meningitis and abusive head trauma similar? In a word, no. There were significant differences in demographic, HPI, and clinical characteristics.
While I would encourage you to read the article for all of the details, some of the differences included:
- Patients with abusive head trauma were more likely to have an unrelated caregiver living in the home.
- Patients with abusive head trauma were much more likely to be afebrile and to have mental status changes.
In fact, the combination of acute mental status change with lack of fever had a positive predictive value of 95% for abuse.
Please read this article, as there are some great clinical pearls that you can show off during morning report when a young child with acute neurologic symptoms is discussed!