Abusive Head Trauma Research Articles

The Strength of the Strengthless: Women, Aged, and Disabled People as a Subversive Force in the Belarusian Protest Movement 2020

ABSTRACT This article examines the Belarusian protests of 2020, triggered by the rigged presidential election results and the illegal disproportionate use of force by the authorities. Given that most protesters were apolitical before 2020, the article seeks to clarify how it happened that passive vulnerable individuals were unprecedentedly mobilized for sustained collective political action. The author focuses on protest actions organized by particularly vulnerable social groups (women, pensioners, the disabled) and reveals their importance for the democratic protest against the patriarchal-authoritarian order. The article traces three stages in the protest development: the moment of traumatic shaking, the caesura of the political sublime, and the rapid scale of the peaceful protest movement characteristically represented by the social groups in question. It is argued that their protest actions had a subversive effect with respect to the autocratic rule and re-actualized an alternative normative and axiological horizon in a given life-world.

A Scientometric Review of Infant Cry and Caregiver Responsiveness: Literature Trends and Research Gaps over 60 Years of Developmental Study.

Infant cry is an adaptive signal of distress that elicits timely and mostly appropriate caring behaviors. Caregivers are typically able to decode the meaning of the cry and respond appropriately, but maladaptive caregiver responses are common and, in the worst cases, can lead to harmful events. To tackle the importance of studying cry patterns and caregivers' responses, this review aims to identify key documents and thematic trends in the literature as well as existing research gaps. To do so, we conducted a scientometric review of 723 documents downloaded from Scopus and performed a document co-citation analysis. The most impactful publication was authored by Barr in 1990, which describes typical developmental patterns of infant cry. Six major research thematic clusters emerged from the analysis of the literature. Clusters were renamed "Neonatal Pain Analyzer" (average year of publication = 2002), "Abusive Head Trauma" (average year of publication = 2007), "Oxytocin" (average year of publication = 2009), "Antecedents of Maternal Sensitivity" (average year of publication = 2010), "Neurobiology of Parental Responses" (average year of publication = 2011), and "Hormonal Changes & Cry Responsiveness" (average year of publication = 2016). Research clusters are discussed on the basis of a qualitative inspection of the manuscripts. Current trends in research focus on the neurobiology of caregiver responses and the identification of factors promoting maternal sensitivity. Recent studies have also developed evidence-based strategies for calming crying babies and preventing caregivers' maladaptive responses. From the clusters, two topics conspicuously call for future research: fathers' responsiveness to infant cry and the impact of caregiver relationship quality on cry responsiveness.

'Compressed Baby Head': A New 'Abusive Head Trauma' Entity?

Child abuse represents an important issue in the medico-legal and social context. In the last few decades, various aspects and mechanisms have been identified in child abuse case studies; however, constant research is needed in the field. With this paper, the authors will present a case of a new entity of Abusive Head Trauma that has come to the attention of medico-legal experts. The trauma analysis performed on the cranio-encephalic district of the baby revealed quite peculiar lesions that led the authors to exclude that the injuries had been solely caused by violent shaking of the baby's head, as suggested by Shaken Baby Syndrome. Instead, the authors hypothesised that another lesion mechanism had been added to this one, namely latero-lateral cranial compression. The comprehensive and exhaustive analysis of the case led the authors to present a new possible entity in child abuse trauma, namely 'Compressed Baby Head'. To the best of our knowledge, in the current literature, no similar clinical cases have ever been described. Thus, the case's uniqueness deserves to be brought to the attention of experts and the entire scientific community, as well as medical personnel, paediatricians, and reanimators. These professional figures are the first individuals who may encounter complex clinical cases such as the one presented in this paper; thus, they need to know how to properly manage the case and ensure protection for the abused infants and children.

ICD-10 codes for surveillance of non-fatal abusive head trauma in Aotearoa New Zealand: a retrospective cohort study

ObjectivesTo assess the validity of an International Classification of Diseases (ICD) code based definition of non-fatal head trauma caused by child abuse (abusive head trauma) for population surveillance in New...

Comparisons of characteristics and outcome between abusive head trauma and non-abusive head trauma in a pediatric intensive care unit

Abusive head trauma (AHT) is the leading cause of death in infants with traumatic brain injury (TBI). Early recognition of AHT is important for improving outcomes, but it can be challenging due to its similar presentations with non-abusive head trauma (nAHT). This study aims to compare clinical presentations and outcomes between infants with AHT and nAHT, and to identify the risk factors for poor outcomes of AHT. We retrospectively analyzed infants of TBI in our pediatric intensive care unit from January 2014 to December 2020. Clinical manifestations and outcomes were compared between patients with AHT and nAHT. Risk factors for poor outcomes in AHT patients were also analyzed. 60 patients were enrolled for this analysis, including 18 of AHT (30%) and 42 of nAHT (70%). Compared with those with nAHT, patients with AHT were more likely to have conscious change, seizures, limb weakness, and respiratory failure, but with a fewer incidence of skull fractures. Additionally, clinical outcomes of AHT patients were worse, with more cases undergoing neurosurgery, higher Pediatric Overall Performance Category score at discharge, and more anti-epileptic drug (AED) use after discharge. For AHT patients, conscious change is an independent risk factor for a composite poor outcome of mortality, ventilator dependence, or AED use (OR=21.9, P=0.04) CONCLUSIONS: AHT has a worse outcome than nAHT. Conscious change, seizures and limb weaknesses but not skull fractures are more common in AHT. Conscious change is both an early reminder of AHT and a risk factor for its poor outcomes.

Repetitive mild traumatic brain injuries in children of abuse

Repetitive mild traumatic brain injuries in children of abuse

New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review.

(1) Background: Head trauma represents the first cause of death in abused children, but diagnostic knowledge is still limited. The characteristic findings of abusive head trauma (AHT) are retinal hemorrhages (RH) and additional ocular findings, including optic nerve hemorrhages (ONH). However, etiological diagnosis must be cautious. (2) Methods: The Preferred Reporting Items for Systematic Review (PRISMA) standards were employed, and the research focus was the current gold standard in the diagnosis and timing of abusive RH. (3) Results: Sixteen articles were included for qualitative synthesis. The importance of an early instrumental ophthalmological assessment emerged in subjects with a high suspicion of AHT, with attention to the localization, laterality, and morphology of the findings. Sometimes it is possible to observe the fundus even in deceased subjects, but the current techniques of choice consist of Magnetic Resonance Imaging and Computed Tomography, also useful for the timing of the lesion, the autopsy, and the histological investigation, especially if performed with the use of immunohistochemical reactants against erythrocytes, leukocytes, and ischemic nerve cells. (4) Conclusions: The present review has made it possible to build an operational framework for the diagnosis and timing of cases of abusive retinal damage, but further research in the field is needed.

Occult fractures detected on radiographs in young children with a concern for abusive head trauma.

To determine the incidence of children < 2 years old with suspected abusive head trauma, to evaluate usage of dedicated skeletal radiographs and the incidence of clinically occult fractures on dedicated skeletal radiographs. This is a retrospective single centre study of children < 2 years old with traumatic brain injury, referred to the University Hospital's Social Services Department between December 31, 2012 and December 31, 2020. Clinical and demographic data was retrieved from medical notes and imaging was reviewed by paediatric radiologists. 26 children (17 males), 2 weeks to 21 months of age (median age 3 months) were included. Eleven children (42%) had traumatic history, fourteen children (54%) had one or more bruises, eighteen children (69%) had abnormal neurological findings. 16 children (62%) had dedicated skeletal radiographs, 7 children (27%) had radiographs of part of the skeleton and 3 children (11%) had no skeletal radiographs. 5 out of 16 children (31%) with dedicated skeletal radiographs had a clinically occult fracture. 15 (83%) of clinically occult fractures had high specificity for abuse. The incidence of suspected abusive head trauma in children < 2 years old is low. Clinically occult fractures were detected in one third of children with dedicated skeletal radiographs. The majority of these fractures have high specificity for abuse. Dedicated skeletal imaging is not performed in more than one third of the children and hence fractures may be missed. Efforts should be taken to increase awareness of child abuse imaging protocols.

Parental Knowledge and Awareness about Shaken Baby Syndrome in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Despite the serious consequences of shaken baby syndrome (SBS), previous studies revealed a low level of knowledge among Saudi parents. This is a cross-sectional study. An electronic questionnaire was distributed through social media platforms to parents of pediatric age group children in Jeddah, Saudi Arabia. A total of 524 responses were received. Data about participants' demographics, knowledge, attitude, and practice regarding SBS were collected through convenient random sampling. A total of 524 responses were received; 30.7% of the participants were familiar with SBS. The Internet and the social media platforms were the most common sources of information. There was no statistically significant correlation between knowledge levels and participants' sociodemographic factors; only 32.3% of individuals had good knowledge. Of them, 84% had a positive attitude towards learning more about SBS, and 40.1% and 34.3% were interested in learning more about SBS before and during pregnancy, respectively. Carrying the baby and shaking were the actions most frequently taken when a baby was crying. Of them, 23.9% forcefully shake their child, while 41.4% of them throw their infant up in the air and catch it. It is important to conduct health education programs on SBS for mothers throughout the prenatal period.

Imaging of Abusive Head Trauma in Children.

In this article, we describe relevant anatomy, mechanisms of injury, and imaging findings of abusive head trauma (AHT). We also briefly address certain mimics of AHT, controversies, pearls, and pitfalls. Concepts of injury, its evolution, and complex nature of certain cases are highlighted with the help of case vignettes.

Early neurobehavioral outcomes in infants with suspected abusive head trauma: Performance across and relationship between measures

Early neurobehavioral outcomes among infants with abusive head trauma (AHT) have not been well characterized. Though there are standardized measures for assessing infants, the ability of these measures to detect deficits may be limited. The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale, Second Edition (NNNS-II) has been correlated with neurobehavioral outcomes as early as birth but has not been used with this clinical group. There is no strong evidence of the concurrent validity of this measure. The primary goal was to examine the concurrent validity of the NNNS-II in patients with suspected AHT by comparing it to the Mullen Scales of Early Learning, American Guidance Service (AGS) Edition (Mullen). A secondary goal was to characterize early neurobehavioral outcomes among infants with suspected AHT across two measures. This retrospective study included 11 infants who sustained a traumatic brain injury (TBI) around 40 days of age. The sample’s performance was variable and ranged from average to below average across measures. Participants experienced the most difficulty with visuospatial processing, attentional abilities, physiologic regulation, and asymmetric reflexes, and data suggested the NNNS-II may be more sensitive to deficits. There was evidence of concurrent validity of the NNNS-II based on strong to moderate correlations with the Mullen. Use of the NNNS-II shortly after the injury is more likely to showcase deficits, which may increase the likelihood that patients receive early intervention. Establishing concurrent validity of the NNNS-II further contributes to the evidence base regarding its criterion related validity, which may promote its more regular use.

Post-traumatic Seizures in Children with Abusive Head Trauma (S2.007)

<h3>Objective:</h3> Our objectives were to study the incidence and risk factors for PTS, utilization of continuous EEG (cEEG), management with anti-epileptic drugs (AEDs) and clinical outcomes in victims of AHT. <h3>Background:</h3> Abusive head trauma (AHT) causes death and disability in children. Post-traumatic seizures (PTS) are common in AHT and cause secondary neurological injury. The study of the characteristics and true burden of PTS is important to develop effective management strategies. <h3>Design/Methods:</h3> We assembled an eleven-year cohort of children aged 0–3 years, who suffered AHT and were subsequently admitted to an academic children’s hospital. Data pertinent to demographics, clinical features, management and follow up were collected by retrospective chart review and analyzed. <h3>Results:</h3> Sixty out of ninety-two AHT victims developed PTS during hospitalization. Mean age was 6 ±5.8 months and predominantly consisted of males (65%). Factors associated with higher likelihood of seizures were subdural hematoma (OR 5.32 [95% CI 1.27–22.2]) and comorbidities like prematurity (OR 5.45 [95% CI 1.16–25.48]). Over 90% of PTS, occurred within a week of hospitalization. Of those, only three cases had purely electrographic seizures. Mean time to cEEG initiation was 14.7 hours. Nearly 50% of seizures continued sub-clinically, despite clinical control. Although levetiracetam was most commonly used, monotherapy with the same was ineffective in &gt;50%. In comparison to AHT patients without seizures, PTS patients had longer ICU and hospital stays, by 4.1 and 7.8 days respectively. Although, majority (80%) were discharged on AEDs, 40% were weaned off at follow-up. Among PTS patients, mortality rate was &lt;5% with the most common long-term sequelae being developmental delay and epilepsy. <h3>Conclusions:</h3> To date, this is the largest cohort study to examine PTS in young AHT victims. While most PTS were clinical and occurred early, cEEG monitoring was essential in detection and treatment of subclinical seizures. Overall, PTS had a good survival rate and outcomes. <b>Disclosure:</b> Dr. Ahmed Khan has nothing to disclose. Dr. Goretzke has nothing to disclose. Dr. Calamur has nothing to disclose.

Outcomes in Children with Shaken Baby Syndrome and Seizures (P14-9.009)

<h3>Objective:</h3> The present study aims to elucidate the factors contributing to poor outcomes in patients with acute seizures following Shaken Baby Syndrome (SBS). <h3>Background:</h3> SBS is the most common cause of severe neurological injury resulting from child abuse and is associated with subdural and retinal hemorrhages. Seizures are a common yet underdiagnosed feature of this syndrome and are associated with poor outcomes. <h3>Design/Methods:</h3> We retrospectively identified patients with SBS and seizures who were diagnosed between 2015–2020. Detailed chart review was performed under IRB-approved study criteria. Demographic, clinical, imaging, lab, and neurophysiology studies information was systematically collected. Logistic regression analysis was used to evaluate factors contributing to poor outcomes. <h3>Results:</h3> A total of 23 patients with acute seizures following SBS were included. The mean age was 7 months (range 3 weeks - 4 years). Six(26%) patients had a presenting GCS of 7 or less, while status epilepticus presented in 7(30%) patients. All included patients had acute traumatic subdural hematoma, retinal hemorrhage, and seizures in the acute period. Overall mortality was 2(9%). Logistic regression analysis identified craniotomy (p:0.01, OR:215.00; 95% CI 3.45–13408.47), SDH thickness &gt;1 cm (p:0.02, OR:68.33; 95% CI 2.15–2173.12), midline shift &gt;1 mm (p:0.03, OR:39.00; 95% CI 1.42–1067.60), and age &gt;24 months (p:0.01, OR:215.00; 95% CI 3.45–13408.47) as predictors of mortality in both univariate and multivariate analysis. Of note, 19(83%) patients had an elevated serum glucose on presentation. <h3>Conclusions:</h3> Seizures in Shaken Baby Syndrome are associated with acute traumatic subdural hematoma, and about 1 in 3 children will develop status epilepticus. Patients with craniotomy to evacuate SDH, SDH thickness &gt;1 cm, midline shift &gt;1 mm, and older age at the time of injury have a worse prognosis. <b>Disclosure:</b> Miss Stebbins has nothing to disclose. Dr. Mohammed has nothing to disclose. The institution of Dr. Shah has received research support from Eisai pharma .

Trends in Early MRI Utilization in Critically Ill Children with Severe TBI: a Single Center Experience, 2010–2021 (P14-9.012)

<h3>Objective:</h3> To characterize acquisition and timing of early magnetic resonance imaging (MRI) in children hospitalized with severe traumatic brain injury (TBI). <h3>Background:</h3> MRI identifies brain injury that may provide prognostic data. Utilization and prognostic value of MRI during the acute post-injury period in children with severe TBI are poorly characterized. <h3>Design/Methods:</h3> From our site’s National Trauma Data Bank, we identified children (3 to 18 years) admitted from 2010 to 2021 for severe TBI (post-resuscitation Glasgow Coma Scale [GCS] &lt; 9) who required mechanical ventilation. We excluded patients with suspected abusive head trauma and deaths ≤ 48 hours after presentation. We collected demographic and clinical characteristics, and acquisition and timing of MRIs obtained during hospitalization. Data were summarized as median [interquartile range] and frequency (percent). To assess practice evolution, we compared MRI utilization across three time periods (2010–2013, 2014–2017, 2018–2021) using Kruskal-Wallis and Fisher’s exact tests. <h3>Results:</h3> Of the 260 patients (median 11 [7–14] years; 64% boys; median GCS 3 [3–6]), 170 (65%) had an MRI with median time to MRI 3 [2–6] days. Patients who had an MRI had higher injury severity scores, more frequently underwent intracranial pressure monitoring, and had longer intensive care unit stays and durations of mechanical ventilation (p&lt;0.05). Across the time periods, patient and injury characteristics were similar as was the proportion of patients who had an MRI. When patients did undergo MRI, it was more commonly obtained within 7 days of injury if they were admitted later in the study period (2018–2021: 67/70 (97%), 2014–2017: 50/60 (83%), 2010–2013: 28/40 (70%), p = 0.001). <h3>Conclusions:</h3> Although overall MRI utilization for children hospitalized with severe TBI remained stable over time, our institution is increasingly obtaining MRIs within the first 7 days. Further study is needed to determine prognostic value of early MRI. <b>Disclosure:</b> Dr. Janas has nothing to disclose. Mrs. Campbell has nothing to disclose. Dr. Ruzas has nothing to disclose. Dr. Messer has nothing to disclose. Nicholas Stence has nothing to disclose. Dr. Samples has nothing to disclose. The institution of Dr. Wyrwa has received research support from Foundation for Physical Medicine and Rehabilitation. The institution of Dr. Fink has received research support from NIH. The institution of Dr. Fink has received research support from Neurocritical Care Society. Dr. Fink has received personal compensation in the range of $500-$4,999 for serving as a Subboard member PCCM with American Board of Pediatrics. The institution of Dr. Maddux has received research support from NIH/NICHD. The institution of Dr. Maddux has received research support from CDC.

Intracranial hypertension in a child with abusive head trauma

Intracranial hypertension in a child with abusive head trauma

Utility of balanced steady-state field precession sequence in the evaluation of retinal and subdural hemorrhages in patients with abusive head trauma.

Abusive head trauma is the leading cause of physical child abuse deaths in children under 5years of age in the United States. To evaluate suspected child abuse, radiologic studies are typically the first to identify hallmark findings of abusive head trauma including intracranial hemorrhage, cerebral edema, and ischemic injury. Prompt evaluation and diagnosis are necessary as findings may change rapidly. Current imaging recommendations include brain magnetic resonance imaging with the addition of a susceptibility weighted imaging (SWI) sequence which can detect additional findings that suggest abusive head trauma including cortical venous injury and retinal hemorrhages. However, SWI is limited due to blooming artifacts and artifacts from the adjacent skull vault or retroorbital fat, which can affect the evaluation of retinal, subdural, and subarachnoid hemorrhages. This work explores the utility of the high-resolution, heavily T2 weighted balanced steady-state field precession (bSSFP) sequence to identify and characterize retinal hemorrhage and cerebral cortical venous injury in children with abusive head trauma. The bSSFP sequence provides distinct anatomical images to improve the identification of retinal hemorrhage and cortical venous injury.

Current Approaches to Screening for Child Physical Abuse and Abusive Head Trauma

Current Approaches to Screening for Child Physical Abuse and Abusive Head Trauma

Non-accidental head injury in children: medical care direct economic cost in a tertiary care hospital

Non-accidental head injury in children: medical care direct economic cost in a tertiary care hospital

Shaken baby syndrome, due process and scientific disagreement.

Shaken baby syndrome, due process and scientific disagreement.

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages

PurposeFunction and anatomy of the visual system were evaluated in children with abusive head trauma (AHT). The relationships between retinal hemorrhages at presentation were examined with outcome measures.MethodsRetrospective review of data in children with AHT for 1) visual acuity at last follow-up, 2) visual evoked potentials (VEP) after recovery, 3) diffusion metrics of white matter tracts and grey matter within the occipital lobe on diffusion tensor imaging (DTI), and 4) patterns of retinal hemorrhages at presentation. Visual acuity was converted into logarithm of minimum angle of resolution (logMAR) after correction for age. VEPs were also scored by objective signal-to-noise ratio (SNR).ResultsOf 202 AHT victims reviewed, 45 met inclusion criteria. Median logMAR was reduced to 0.8 (approximately 20/125 Snellen equivalent), with 27% having no measurable vision. Thirty-two percent of subjects had no detectable VEP signal. VEPs were significantly reduced in subjects initially presenting with traumatic retinoschisis or hemorrhages involving the macula (p < 0.01). DTI tract volumes were decreased in AHT subjects compared to controls (p < 0.001). DTI metrics were most affected in AHT victims showing macular abnormalities on follow-up ocular examination. However, DTI metrics were not correlated with visual acuity or VEPS. There was large inter-subject variability within each grouping.DiscussionMechanisms causing traumatic retinoschisis, or traumatic abnormalities of the macula, are associated with significant long-term visual pathway dysfunction. AHT associated abnormalities of the macula, and visual cortical pathways were more fully captured by VEPs than visual acuity or DTI metrics.