Abstract
Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality and is categorized as abusive head trauma (AHT) and accidental head injury. A retrospective chart review of 124 children aged <1 year diagnosed with TBI were analyzed. Outcomes were evaluated at discharge and 6 months later by using the Pediatric Cerebral Performance Category (PCPC) Scale. The receiver operating characteristic (ROC) curve was applied to determine the cutoff values for hemoglobin (HB) levels. In the study, 50 infants (40.3%) achieved a favorable neurologic outcome (PCPC ≦ 2) and 74 (59.7%) had poor neurologic outcomes (PCPC ≧ 3). Infants with poor neurologic outcomes had lower HB on admission and nadir HB (p < 0.05). Based on multivariate logistic regression analysis, the nadir HB was a predictor of poor neurologic outcomes at discharge and 6 months later in both AHT and accidental head injury. Nadir HB had the largest area under the ROC curve for predicting poor neurologic outcomes. We determined the appropriate cutoff value of nadir HB as 9.35 g/dl for predicting neurologic outcomes in infants with TBI. Furthermore, the cutoff value of nadir HB in predicting poor neurologic outcomes in infants caused by AHT and accidental head injury were taken as 9.36 and 8.75 g/dl, respectively.
Highlights
Physical abuse and neglect are the major types of child maltreatment and affect an increasing number of children in the world [1]
From January 2006 to 2017, we retrospectively collected data from infants aged
A total of 124 infants with ICH confirmed by brain computed tomography (CT) at admission were included in this study
Summary
Physical abuse and neglect are the major types of child maltreatment and affect an increasing number of children in the world [1]. Intracranial hemorrhage is frequent after TBI in infants due to the highly vascularized nature of the brain and is associated with poor outcomes. About two thirds of AHT and quarter of accidental head injury have the feature of subdural hemorrhage (SDH). Epidural hemorrhages (EDH) were significantly associated with accidental head injury rather than AHT (17 vs 4 percent, respectively) [6]. It is important to analyze the risk factors associated with morbidity and mortality in infants with traumatic intracranial hemorrhage to develop guidelines for adequate treatment to prevent further complications such as higher brain dysfunction
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