A 3-month-old patient is brought to the emergency department due to caregiver reports of lethargy. Computerized tomography of the head reveals a subdural hemorrhage. Which diagnostic should be included in the patient's plan of care?
Answer (2)
In this scenario, the 3-month-old patient exhibits signs of lethargy and a medical imaging test, computed tomography (CT) of the head, has demonstrated a subdural hemorrhage. This condition is concerning and warrants further investigation to determine the underlying cause.
Key Considerations:
Potential Causes:
In infants, a common cause of subdural hemorrhage is non-accidental trauma, often referred to as abusive head trauma or "shaken baby syndrome."
Other potential causes might include accidental trauma, certain medical conditions, or bleeding disorders.
Diagnostics to Include:
Ophthalmologic Examination: To check for retinal hemorrhages, which are commonly associated with abusive head trauma.
Complete Blood Count (CBC) and Coagulation Studies: To assess for any bleeding disorders that might explain the hemorrhage.
Head MRI: May be done for further evaluation of brain tissue and to assess the extent of the hemorrhage and any potential brain injury.
Skeletal Survey: To check for any signs of other bone injuries or fractures that could indicate non-accidental trauma.
Next Steps:
It is crucial to involve social services if there is suspicion of abuse.
A multidisciplinary approach involving pediatricians, radiologists, social workers, and oftentimes law enforcement may be necessary to ensure the child’s safety and well-being.
This diagnosis and management should always be approached with careful consideration of all possible causes and with sensitivity to the needs and safety of the patient. Always prioritize non-confrontational communication and support for the caregivers until clear conclusions are drawn.
The diagnostic plan for the 3-month-old with subdural hemorrhage should include an ophthalmologic examination, CBC and coagulation studies, head MRI, and a skeletal survey to investigate potential causes, including abusive head trauma. Involvement of social services is crucial if abuse is suspected. A multidisciplinary approach ensures comprehensive care and support for the patient and family.
;
