Biomedical subjects

S A Schutzman

Publications and source records attributed to S A Schutzman.

16 recordsLinked to original sources

PubMed2001

Pediatric minor head trauma.

Head trauma is one of the most common childhood injuries, annually accounting for more than 500,000 emergency department visits, 95,000 hospital admissions, 7,000 deaths, and 29,000 permanent disabilities; hospital care costs alone exceed $1 billion annually. The majority of patients have minor head trauma, and, although most of these injuries are insignificant, minor head trauma causes a large number of intracranial injuries. The largest reduction in head trauma mortality rates results from preventing deterioration and secondary brain injury in patients with minor or moderate head injuries who initially appear to be at low risk. The goal of the clinician, therefore, is to identify those at risk for intracranial injury and subsequent deterioration, while limiting unnecessary imaging procedures. This article reviews the current data and practice in assessing and treating minor head trauma in children.

Athletic Injuries↗

PubMed2001

Clinical significance of scalp abnormalities in asymptomatic head-injured infants.

OBJECTIVES: 1) To identify clinical features indicating a high risk of skull fracture (SF) and associated intracranial injury (ICI) in asymptomatic head-injured infants. 2) To develop a clinical decision rule to determine which asymptomatic head-injured infants require head imaging. METHODS: We performed a prospective cohort study of all asymptomatic head-injured infants 0-24 months of age presenting to the emergency department of an urban children's hospital. Infants were considered asymptomatic if they had no clinical signs of brain injury, or of basilar or depressed SF. Among subjects who had head imaging, we assessed the utility of age, scalp hematoma size, and scalp hematoma location for predicting SF and ICI. RESULTS: Of 422 study patients, 45 (11 %) were diagnosed with SF and 13 (3%) with ICI. In the 172 subjects who had head imaging, there was a stepwise relationship between hematoma size and likelihood of SF. Parietal and temporal hematomas were highly associated with SF; frontal hematomas were not. There was a trend toward higher rates of SF in younger patients. Both large scalp hematoma and parietal hematoma were associated with ICI. Using these data, we developed a clinical decision rule to determine which asymptomatic infants need head imaging. In our study population, this rule has a sensitivity of 0.98 and specificity of 0.49 for SF, and it detects all 13 cases of ICI. The clinical rule calls for imaging in 146/422 (35%) study subjects. CONCLUSIONS: Among asymptomatic head-injured infants, the risk of SF and associated ICI is correlated with scalp hematoma size, hematoma location, and weakly with patient age. We propose a clinical decision rule that could identify most cases of SF and ICI while not requiring head imaging for most patients. This decision rule should be validated in other study populations.

Age Factors↗

PubMed2001

Role of flexion-extension radiographs in blunt pediatric cervical spine injury.

OBJECTIVE: To determine whether flexion-extension cervical spine radiography (FECSR) is abnormal in children who have sustained blunt cervical spine injury (CSI) when standard cervical spine radiography (SCSR) demonstrates no acute abnormalities. METHODS: This was a blinded radiographic review of 129 patients < or = 16 years of age evaluated at an academic pediatric trauma center during July 1990-March 1996. All patients had SCSR (anteroposterior/lateral views) and FECSR performed for a trauma-related event within seven days of injury. RESULTS: Of 46 patients without acute abnormalities on SCSR, one patient (with final clinical diagnosis of "no CSI") had acute abnormalities on FECSR (95% CI = 0.06% to 11.5%). Of 50 patients with isolated loss of lordosis on SCSR, no patient had acute abnormalities on FECSR (95% CI = 0% to 5.8%). The FECSR review revealed no acute abnormalities in 75 of 83 patients (90.4%) with suspicious findings for CSI viewed on SCSR (95% CI = 81.9% to 95.7%). Complications during FECSR were noted in one patient with transient paresthesias (0.8%) (95% CI = 0.02% to 4.2%). CONCLUSIONS: In children who underwent acute radiographic evaluation of blunt cervical spine trauma, FECSR was unlikely to be abnormal when no acute abnormality or isolated loss of lordosis was evident on SCSR. In a subset of patients with suspicious findings for occult CSI on SCSR, FECSR was useful in ruling out ligamentous instability in the acute, posttrauma setting.

Adolescent↗

PubMed2001

Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines.

OBJECTIVE: In children <2 years old, minor head trauma (HT) is a common injury that can result in skull fracture and intracranial injury (ICI). These injuries can be difficult to detect in this age group; therefore, many authors recommend a low threshold for radiographic imaging. Currently, no clear guidelines exist regarding the evaluation and management of head-injured infants. We sought to develop guidelines for management based on data and expert opinion that would enable clinicians to identify children with complications of HT and reduce unnecessary imaging procedures. METHODS. EVIDENCE: References addressing pediatric HT were generated from a computerized database (Medline). The articles were reviewed and evidence tables were compiled. EXPERT PANEL: The multidisciplinary panel was comprised of nine experts in pediatric HT. CONSENSUS PROCESS: A modified Delphi technique was used to develop the guidelines. Before the one meeting, panel members reviewed the evidence and formulated answers to specific clinical questions regarding HT in young children. At the meeting, guidelines were formulated based on data and expert consensus. RESULTS: A management strategy was developed that categorizes children into 4 subgroups, based on risk of ICI. Children in the high-risk group should undergo a computed tomography (CT) scan. Those in the intermediate risk group with symptoms of possible ICI should either undergo CT scan or observation. Those in the intermediate risk group with some risk for skull fracture or ICI should undergo CT and/or skull radiographs or observation. Those in the low-risk group require no radiographic imaging. CONCLUSIONS: We have developed a guideline for the evaluation of children <2 years old with minor HT. The effect of these guidelines on clinical outcomes and resource utilization should be evaluated.

Brain Injuries↗

PubMed1999

Head trauma in children younger than 2 years: are there predictors for complications?

OBJECTIVES: To determine the incidence of skull fracture (SF) and intracranial injury (ICA) among children younger than 2 years evaluated in a pediatric emergency department for head trauma; whether historical features and/or physical findings are predictive of injury type; and whether clinical criteria could allow a selective approach to radiographic imaging. DESIGN: Retrospective medical record review. SETTING: Tertiary pediatric emergency department. PATIENTS: Case series of 278 children aged younger than 24 months evaluated for head injury. MAIN OUTCOME MEASURES: Presence of SF and/or ICA. RESULTS: Diagnoses at discharge included 227 minor head injuries, 39 isolated SF, 9 ICA with SF, and 3 isolated ICA. Children younger than 12 months had the highest incidence of SF/ICA (29%) vs 4% for children aged 13 to 24 months (P<.001). Seven percent of complications from SF/ICA resulted from falls 3 ft (0.9 m) or less [corrected]. Incidence of behavioral change, loss of consciousness, emesis, and seizures did not differ significantly between those with minor head injuries and those with SF/ICA. Scalp abnormalities were more common in children with SF/ICA (P<.001). Sixty-two percent of children with isolated SF and 58% of children with ICA had no history of loss of consciousness, emesis, seizure, or behavioral change. Ninety-two percent of children with isolated SF and 75% of children with ICA had normal levels of consciousness and nonfocal neurologic examinations at diagnosis. Among children who fell 3 ft or less (0.9 m) [corrected] and had no loss of consciousness, emesis, seizure, behavioral change, or scalp abnormality, none of 31 (95% confidence interval [CI], 0-0.10) children younger than 24 months and none of 20 (95% CI, 0-0.15) children younger than 12 months had SF/ICA. CONCLUSIONS: Both SF and ICA are common in children younger than 2 years evaluated for head trauma. Children younger than 12 months are at highest risk. Injuries resulted from relatively minor falls and occurred in alert, neurologically normal children. Clinical signs and symptoms were insensitive predictors of SF/ICA; however, a grouping of features (fall < or = 3 ft [0.9 m], no history of neurologic symptoms, and normal scalp physical examination results) identified a subset of children at low risk for complications.

Accidental Falls↗

PubMed1999

Clinical indicators of intracranial injury in head-injured infants.

OBJECTIVES: 1) To determine whether clinical signs of brain injury are sensitive indicators of intracranial injury (ICI) in head-injured infants. 2) To determine whether radiographic imaging of otherwise asymptomatic infants with scalp hematoma is a useful means of detecting cases of ICI. 3) To determine whether head-injured infants without signs of brain injury or scalp hematoma may be safely managed without radiographic imaging. METHODS: We performed a 1-year prospective study of all infants younger than 2 years of age presenting to a pediatric emergency department with head trauma. Data were collected on historical features, physical findings, radiographic findings, and hospital course. Follow-up telephone calls were made 2 weeks after discharge to assess for any late deterioration. RESULTS: Of 608 study subjects, 30 (5%) had ICI; 12/92 (13%) infants 0 to 2 months of age had ICI, compared with 13/224 (6%) infants 3 to 11 months of age, and 5/292 (2%) infants 12 months of age or older. Only 16/30 (52%) subjects with ICI had at least one of the following clinical symptoms or signs of brain injury: loss of consciousness, history of behavior change, seizures, emesis, depressed mental status, irritability, bulging fontanel, focal neurologic findings, or vital signs indicating increased intracranial pressure. Of the 14 asymptomatic subjects with ICI, 13 (93%) had significant scalp hematoma. Among subjects who had head computed tomography, significant scalp hematoma had an odds ratio of 2.78 (95% confidence interval: 1.15,6.70) for association with ICI. A total of 265 subjects (43%) were asymptomatic and had no significant scalp hematoma. None (95% confidence interval: 0,1.2%) required specific therapy or had any subsequent clinical deterioration. CONCLUSIONS: Clinical signs of brain injury are insensitive indicators of ICI in infants. A substantial fraction of infants with ICI will be detected through radiographic imaging of otherwise asymptomatic infants with significant scalp hematomas. Asymptomatic infants older than 3 months of age who have no significant scalp hematoma may be safely managed without radiographic imaging.

Analysis of Variance↗

PubMed1998

Occult intracranial injury in infants.

STUDY OBJECTIVES: The objectives of this study were as follows: (1) to determine whether clinical symptoms and signs of brain injury are sensitive indicators of intracranial injury (ICI) in infants admitted with head trauma, (2) to describe the clinical characteristics of infants who have ICI in the absence of symptoms and signs of brain injury, and (3) to determine the clinical significance of those ICIs diagnosed in asymptomatic infants. METHODS: We conducted a retrospective analysis of all infants younger than 2 years of age admitted to a tertiary care pediatric hospital with acute ICI during a 6(1/2)-year period. Infants were considered symptomatic if they had loss of consciousness, history of behavior change, seizures, vomiting, bulging fontanel, retinal hemorrhages, abnormal neurologic examination, depressed mental status, or irritability. All others were considered to have occult ICI. RESULTS: Of 101 infants studied, 19 (19%; 95% confidence interval [CI] 12%, 28%) had occult ICI. Fourteen of 52 (27%) infants younger than 6 months of age had occult ICI, compared with 5 of 34 (15%) infants 6 months to 1 year, and none of 15 (0%) infants older than 1 year. Eighteen (95%) infants with occult ICI had scalp contusion or hematoma, and 18 (95%) had skull fracture. Nine (47%) infants with occult ICI received therapy for the ICI. No infants with occult ICI (0%) (95% CI 0, 14%) required surgery or medical management for increased intracranial pressure. Only 1 subject (5%) with occult ICI had any late symptoms or complications: a brief, self-limited convulsion. CONCLUSION: We found that 19 of 101 ICIs in infants admitted with head trauma were clinically occult. All 19 occult ICIs occurred in infants younger than 12 months of age, and 18 of 19 had skull fractures. None experienced serious neurologic deterioration or required surgical intervention. Physicians cannot depend on the absence of clinical signs of brain injury to exclude ICI in infants younger than 1 year of age.

Acute Disease↗

PubMed1997

Infants with isolated skull fracture: what are their clinical characteristics, and do they require hospitalization?

STUDY OBJECTIVE: We sought to identify the historical factors and physical examination findings typical of infants who have sustained isolated skull fracture (ISF)--in the absence of associated intracranial injury--after head trauma. We also assessed the risk of clinical deterioration (and therefore the need for inpatient observation) in infants with ISF. METHODS: We conducted a retrospective analysis of all patients younger than 2 years admitted to a tertiary care pediatric hospital with a diagnosis of ISF over a 3-year period. RESULTS: During the study period, 101 infants with radiographically proven ISF were admitted to the hospital. Falls were the most common reported mechanism of injury (n = 90 [89%]). Many falls involved short distances: 18 patients (18%) fell less than 3 feet. Nonaccidental trauma was suspected in only 10 patients (10%). Seventy-two patients (71%; 95% confidence interval [CI], 61%, 79%) had at least one of the clinical signs considered potential indicators of serious head injury: initial loss of consciousness, seizures, vomiting, lethargy, irritability, depressed mental status, and focal neurologic findings. In 97 patients (96%; 95% CI, 89%, 98%), local findings of head injury (palpable fracture, soft-tissue swelling, or signs of basilar skull fracture) were noted on physical examination. None of the patients (0%; 95% CI, 0%, 3%) demonstrated clinical decline during hospitalization. All were neurologically normal on discharge. CONCLUSION: A diagnosis of ISF should be considered even in infants with minor mechanisms of head injury who appear well. However, infants with ISF rarely present without local signs of head injury on physical examination. If no other specific clinical concerns necessitate hospital admission, infants with ISF who have reliable caretakers may be considered for discharge home.

Accidental Falls↗

PubMed1996

Prospective study of recurrent radial head subluxation.

OBJECTIVES: To calculate a recurrence rate for radial head subluxation (RHS) and to identify risk factors for recurrence. DESIGN: Prospective cohort study. SETTING: Pediatric emergency department of an urban, tertiary care children's hospital. PATIENTS: Consecutive sample of 107 children younger than 6 years with definite (n = 94) or probable (n = 13) RHS enrolled during a 6-month period and followed up for at least 12 months. MAIN OUTCOME MEASURE: Recurrent episodes of RHS. RESULTS: Follow-up information was available on 86.9% (93/107) patients, with a mean +/- SD of 16.4 +/- 1.9 months (range, 12 to 20 months). Of these 93 patients, 22 (23.7%) had recurrent RHS. Among the patients who had their first episode of RHS during the study period (n = 76), those with recurrences were significantly younger than those without (21.7 +/- 9.9 months vs 29.2 +/- 13.5 months, respectively, P = .04, t test). Those 24 months or younger had a relative risk of 2.60 for one or more recurrences during the study period (95% confidence interval, 1.04 to 6.30) compared with those older than 24 months. No differences were observed in duration of follow-up, sex, elbow involved in the initial episode, or family history of RHS between those with and without recurrences. CONCLUSIONS: Recurrent RHS occurs in nearly one fourth of patients, and those 24 months or younger are at greatest risk. Sex, family history, and the elbow involved in the initial episode are not risk factors for recurrence.

Child, Preschool↗

PubMed1996

Comparison of oral transmucosal fentanyl citrate and intramuscular meperidine, promethazine, and chlorpromazine for conscious sedation of children undergoing laceration repair.

STUDY OBJECTIVE: To compare oral transmucosal fentanyl citrate (OTFC) with IM meperidine, promethazine, and chlorpromazine (MPC) for conscious sedation of children. METHODS: This prospective, randomized, single-blinded study involved a convenience sample of 40 children, 3 to 8 years of age, who presented to an urban pediatric emergency department and required laceration repair. Patients were premedicated with either OTFC (10 to 15 micrograms/kg) and a mock injection or intramuscular MPC (2 mg/kg meperidine, .5 mg/kg promethazine, and .5 mg/kg chlorpromazine) followed by a placebo lozenge. RESULTS: Both OTFC and MPC caused significant reductions in activity scores at 15 to 75 minutes after medication administration. Although the MPC group was more sedated, there was no difference between groups in Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores during the laceration repair or in the suturing physician's assessment of sedation quality (rated excellent or good for 75% and 69% of OTFC and MPC groups, respectively). Two children (both in the OTFC group) had oxygen saturation levels of less than 95% but required only transient supplemental oxygen. Other adverse events were common but not serious; they differed between groups in type but not number, with vomiting in 45% of the OTFC group and prolonged somnolence in 37% of the MPC group. Mean time to discharge was 99 minutes, with no difference between groups. CONCLUSIONS: Both medications reduced activity significantly. Although MPC caused deeper sedation, the medications had comparable effects on patient behavior during the repair and yielded comparable ratings of physician satisfaction. Large numbers of nonserious adverse events occurred in both groups.

Administration, Oral↗

PubMed1995

Upper-extremity impairment in young children.

STUDY OBJECTIVE: To determine the spectrum of disorders in children younger than 6 years with upper-extremity injury or immobility and to identify clinical findings associated with specific disorders. DESIGN: Prospective patient series. SETTING: Urban pediatric emergency department. PARTICIPANTS: Children younger than 6 years seen during a 6-month period with injury or immobility of an upper extremity. RESULTS: We identified 178 episodes of immobility or injury of an upper extremity. Radial head subluxation (RHS) was the most frequent diagnosis (63%; 99 definite and 13 probable), followed by fracture (22%) and soft-tissue injury (STI; 13%). One patient each had humeral osteomyelitis and neurologic impairment. The mean age of children with RHS was significantly less than that of children with fractures (27 +/- 12 months versus 39 +/- 19 months, P < .01); the only diagnoses in children younger than 4 months old were infection and neurologic impairment. Multivariate regression analysis showed point tenderness and swelling correlated with fractures (P < .05). Decreased arm movement, absence of swelling, and a pull as the mechanism of injury correlated with RHS (P < .05). However, arm traction occurred in only 55% of the children with RHS (95% confidence interval = .46 to .64). By 1 week after the evaluation, all children without fractures had recovered, except one each with a sprain, osteomyelitis, and neurologic impairment. CONCLUSION: Most children with arm injury or immobility have bony or soft-tissue trauma, the majority being RHS. Clinical findings varied between diagnoses and may aid the clinician in deciding whether attempted reduction of RHS is indicated or whether radiographs are warranted first. Nontrauma diagnoses are unusual but should be considered, particularly in the child younger than 6 months old. Appropriate immobilization and follow-up are important for the management of children without a clear diagnosis at the initial evaluation.

Arm Injuries↗

PubMed1994

Oral transmucosal fentanyl citrate for premedication of children undergoing laceration repair.

STUDY OBJECTIVE: To evaluate the safety and efficacy of two doses of oral transmucosal fentanyl citrate (OTFC) for premedication of children undergoing laceration repair. DESIGN: Prospective, randomized, nonblinded study. SETTING: Urban pediatric emergency department. PARTICIPANTS: Thirty children aged 2 to 8 years requiring laceration repair. INTERVENTIONS: Premedication with either 10 to 15 micrograms/kg or 15 to 20 micrograms/kg of OTFC. RESULTS: Activity score, vital signs, oxygen saturation, and pain scores were recorded before and after administration of OTFC. Activity scores decreased significantly 15 to 60 minutes after OTFC. The physician suturing the wound rated the child's sedation/pain control as excellent or good in 83% of patients. Vital signs changes were not clinically remarkable. Oxygen saturations remained at 95% or more except in one child who experienced a transient decrease to 91%. Adverse effects were not serious but included vomiting in 20% of the lower-dose group and 47% of the higher-dose group. There were no significant differences between dose groups for activity or pain score changes, physician assessment, discharge times, or adverse events. CONCLUSION: Both doses of OTFC reduced activity with comparable efficacy, with no serious vital signs changes. However, the higher-dose group had a greater number (P = NS) of adverse effects.

Administration, Oral↗

PubMed1994

A comparison of intranasal sufentanil and midazolam to intramuscular meperidine, promethazine, and chlorpromazine for conscious sedation in children.

STUDY OBJECTIVE: To compare intranasal sufentanil and midazolam (IN-SM) with intramuscular meperidine, promethazine, and chlorpromazine (IM-MPC) for sedation in children. DESIGN: Single-blind, randomized, controlled study. SETTING: Urban children's emergency department. PARTICIPANTS: A convenience sample of children aged 1 to 4 years requiring suturing. INTERVENTIONS: IN-SM or IM-MPC. RESULTS: Vital signs, O2 saturation, and anxiety and pain scores were recorded. A 6-point scale was used to assess response to medication, and a 12-point recovery score was used to determine readiness for discharge. Both groups were similar in age and sex distribution. There were no significant adverse effects in either group. Patients tolerated the IN regimen better than the IM regimen. Behavioral scores were lower during repair than at baseline within each group; however, they were not different between groups. Time to discharge was longer and recovery scores were lower (worse) among the IM-MPC group. CONCLUSION: IN-SM is as effective as IM-MPC for sedation in children.

Administration, Intranasal↗

PubMed1993

Epidural hematomas in children.

STUDY OBJECTIVE: To describe the presentation, management, and outcome of children with traumatic epidural hematoma. DESIGN: Retrospective chart review. TYPE OF PARTICIPANTS: Fifty-three children diagnosed with traumatic epidural hematoma on computed tomography scan who were treated at Children's Hospital in Boston between 1980 and 1990. MAIN RESULTS: Twenty-four of 53 children developed an epidural hematoma after a fall of less than 5 ft. At the time of diagnosis, 51 of 53 children had one or more symptoms of vomiting, headache, or lethargy. Twenty-six patients were alert, 21 were responsive to verbal or painful stimuli, and five were unresponsive or posturing. Twenty-one (40%) had acute neurologic deterioration before surgery; however, 20 (38%) were alert with normal vital signs and neurologic examinations at diagnosis. All patients survived, and at the time of discharge 45 had normal examinations and eight had neurologic abnormalities; at follow-up only four of these eight had persistent (although mild) abnormalities. CONCLUSIONS: Although often dramatic in presentation, epidural hematoma may occur after relatively minor head trauma and in alert children with nonfocal neurologic examinations. In our study, incidence of neurologic sequelae increased if abnormal neurologic examination or depressed mental status was present at diagnosis. The outcome of children in this study is improved from that of previous studies, perhaps due to increased use of computed tomography and higher incidence of low- or moderate-impact trauma in this series.

Adolescent↗

PubMed1991

Bacteremia with otitis media.

To investigate the occurrence and outcome of bacteremia associated with otitis media, charts were reviewed from patients who were 3 to 36 months of age, had temperatures greater than or equal to 39 degrees C, and were diagnosed with isolated clinical otitis media. A total of 2982 patients were identified. Blood cultures were obtained from 1666 (56%). Of the 1666 patients, who had blood drawn for cultures, 50 (3.0%) had bacteremia. These included 39 with Streptococcus pneumoniae, 4 with Haemophilus influenzae, 2 with Neisseria meningitidis, 3 with Salmonella species, and 2 with Staphylococcus aureus. The incidence of bacteremia increased at higher temperatures, being 1.9% at temperatures less than or equal to 40 degrees C and 5.0% at temperatures greater than 40 degrees C. Younger children were more likely to have bacteremia; 3.7% less than or equal to 12 months of age, 2.4% 13 to 24 months of age, and 1.9% 25 to 36 months of age had blood culture results that were positive (not significant). Reevaluation of the 50 bacteremic patients showed that 9 patients had continued fever, 3 patients had persistent bacteremia, pneumonia developed in 1 patient, and meningitis developed in 1 patient. It was concluded that (1) 3% of young febrile children with otitis media have bacteremia at the time of evaluation, a rate comparable to that previously reported in children with no focus of infection; (2) the incidence of bacteremia increases at higher temperatures; and (3) most febrile children with otitis media do well. The clinician must therefore weigh the potential benefit of drawing a blood culture to identify children at risk for complications against the inherent cost, inconvenience, and discomfort.

Child, Preschool↗

PubMedDate not supplied

Gender differences in rates of unintentional head injury in the first 3 months of life.

OBJECTIVES: To assess for gender differences in rates of unintentional head injury in infants less than 3 months of age, to assess the circumstances of injury in these patients, and to look for gender-related differences in these circumstances. METHODS: Two separate databases were analyzed. 1) The National Pediatric Trauma Registry (NPTR) was queried for all patients < or = 90 days of age who had been diagnosed with unintentional head trauma between 1990 and 1999. The proportion of males was compared to the expected proportion of 51%, derived from US census data. 2) A prospective cohort of 88 infants < or = 90 days of age who had been treated for unintentional head trauma in an urban pediatric emergency department (ED) was studied. Circumstances of injury and gender-related differences in these circumstances were assessed. RESULTS: In the NPTR database, 600 of 1072 (56%) (95% confidence interval [CI] 0.53, 0.59) infants < or = 90 days of age were boys (P =.001). In the ED cohort, 54 of 88 (62%) (95% CI 0.50, 0.72) subjects were boys (P =.06). In virtually all of the cases described, subjects appeared to be passive participants in the injury. The most commonly reported circumstances of injury were the following: "child left alone on furniture and fell" (n = 39) or "parent dropped child" (n = 27). Boys accounted for 20 (74%) of the subjects in the "parent dropped child" group (P =.04). CONCLUSIONS: Boys outnumber girls among infants less than 3 months of age with unintentional head trauma. These young infants appear to be passive participants in their injuries, which indicates that differences in parenting practices may account for the observed gender differences.

Craniocerebral Trauma↗