Abstract
Children with abusive head trauma tend to have worse outcomes than children with accidental head trauma. However, current predictors of poor outcomes for children with abusive head trauma are still limited. We aim to use clinical data to identify early predictors of poor outcome at discharge in children with abusive head trauma. In the 10-year observational retrospective cohort study, children aged between zero and four years with abusive or accidental head trauma were recruited. Multivariate logistic regression models were applied to evaluate factors associated with poor prognosis in children with abusive head trauma. The primary outcome was mortality or a Glasgow Coma Scale (GCS) motor component score of less than 6 at discharge. A total of 292 head trauma children were included. Among them, 59 children had abusive head trauma. In comparison to children with accidental head trauma, children with abusive head trauma were younger, had more severe head injuries, and experienced a higher frequency of post-traumatic seizures. Their radiologic findings showed common presence of subdural hemorrhage, cerebral edema, and less epidural hemorrhage. They were more in need of neurosurgical intervention. In the multivariate analysis for predictors of poor outcome in children with abusive head trauma, initial GCS ≤ 5 (versus GCS > 5 with the adjusted odds ratio (OR) = 25.7, 95% confidence interval (CI) = 1.5–432.8, p = 0.024) and older age (per year with the adjusted OR = 3.3, 95% CI = 1.2–9.5, p = 0.024) were independently associated with poor outcome. These findings demonstrate the characteristic clinical differences between children with abusive and accidental head trauma. Initial GCS ≤ 5 and older age are predictive of poor outcome at discharge in children with abusive head trauma.
Highlights
Abusive head trauma is an injury to the skull or intracranial contents of an infant or child younger than five years caused by inflicted blunt impact and/or violent shaking [1]
Compared to children with accidental head trauma, children with abusive head trauma were younger (p < 0.001), had more severe injury severity, which presented as a lower initial Glasgow Coma Scale (GCS) score (p < 0.001), and had higher frequency of post-traumatic seizure (p < 0.001)
Children with abusive head trauma were more in need of neurosurgical intervention (p < 0.001)
Summary
Abusive head trauma is an injury to the skull or intracranial contents of an infant or child younger than five years caused by inflicted blunt impact and/or violent shaking [1]. Studies of consecutively admitted infants and preschoolers with head injuries report rates of abusive head trauma ranging from 4% to 24% [3], with greater incidence in children younger than one year [4]. Abusive head trauma is often associated with significant rotational acceleration-deceleration force, which seldom occurs in accidental head injury. Children with abusive head trauma are slightly more often boys, often younger than one year, commonly with impaired consciousness levels when visiting emergency departments, of higher frequency in seizure occurrence, and are often patients with increased rates of retinal hemorrhage and more subdural hematoma (SDH) in neuroimaging findings [5,6]. Understanding the characteristics of abusive head trauma can help alert clinicians to the correct diagnosis and the need for a thorough diagnostic evaluation [6,8,9]
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