Related Experiment Video
Updated: Jul 15, 2026
Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Mechanisms, clinical presentations, injuries, and outcomes from inflicted versus noninflicted head trauma during
Kent P Hymel1, Kathi L Makoroff, Antoinette L Laskey
1Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA. kent.hymel@inova.com
Insights
Inflicted head trauma in infants leads to more severe injuries and poorer neurodevelopmental outcomes compared to noninflicted head trauma. This study highlights critical differences in injury mechanisms and brain damage.
Area of Science:
- Pediatric Traumatology
- Neurodevelopmental Pediatrics
- Forensic Pediatrics
Background:
- Head trauma in young children can have devastating consequences.
- Distinguishing between inflicted and noninflicted head trauma is crucial for accurate diagnosis and management.
- Previous studies have suggested differences in outcomes, but objective verification is needed.
Purpose of the Study:
- To prospectively compare short-term neurodevelopmental outcomes in infants with inflicted versus noninflicted head trauma.
- To objectively identify and explain differences in injury mechanisms and clinical presentation.
- To establish a basis for understanding the long-term impact of head trauma etiology.
Main Methods:
- A prospective, multicentered study of children under 36 months hospitalized with acute head trauma.
- Inclusion criteria included computed tomography (CT) confirmation of head trauma.
- Data collected prospectively included clinical findings, neuroimaging (blinded review), and caregiver interviews; neurodevelopmental assessments were performed at 6 months post-injury.
Main Results:
- Fifty-four eligible subjects were enrolled; 27 survivors completed 6-month follow-up.
- Inflicted head trauma cases (n=11) showed more noncontact injury mechanisms and greater injury depth than noninflicted cases (n=30).
- Inflicted head trauma was associated with increased cardiorespiratory compromise, lower Glasgow Coma Scale scores, prolonged impaired consciousness, and bilateral hypoxic-ischemic brain injury.
Conclusions:
- Infants with inflicted head trauma experience more severe injury mechanisms and deeper brain injuries.
- These injuries frequently result in cardiorespiratory compromise and diffuse cerebral hypoxia-ischemia.
- Young victims of inflicted head trauma exhibit significantly worse neurodevelopmental outcomes at 6 months post-injury.
Objective:
Our goal was to conduct a prospective, multicentered, comparative study that would objectively verify and explain observed differences in short-term neurodevelopmental outcomes after inflicted versus noninflicted head trauma.
Methods:
Children <36 months of age who were hospitalized with acute head trauma confirmed by computed tomography imaging were recruited at multiple sites. Extensive clinical data were captured prospectively, subjects were examined, cranial imaging studies were blindly reviewed, and caregivers underwent scripted interviews. Follow-up neurodevelopmental evaluations were completed 6 months after injury. Head-trauma etiology and mechanisms were categorized by using objective a priori criteria. Thereafter, subject groups with inflicted versus noninflicted etiologies were compared.
Results:
Fifty-four subjects who met the eligibility criteria were enrolled at 9 sites. Of 52 surviving subjects, 27 underwent follow-up assessment 6 months after injury. Etiology was categorized as noninflicted in 30 subjects, inflicted in 11, and undetermined in 13. Compared with subjects with noninflicted head trauma, subjects with inflicted head trauma (1) more frequently experienced noncontact injury mechanisms, (2) sustained greater injury depth, (3) more frequently manifested acute cardiorespiratory compromise, (4) had lower initial Glasgow Coma Scale scores, (5) experienced more frequent and prolonged impairments of consciousness, (6) more frequently demonstrated bilateral, hypoxic-ischemic brain injury, (7) had lower mental developmental index scores 6 months postinjury, and (8) had lower gross motor quotient scores 6 months postinjury.
Conclusions:
Compared with infants with noninflicted head trauma, young victims of inflicted head trauma experience more frequent noncontact injury mechanisms that result in deeper brain injuries, cardiorespiratory compromise, diffuse cerebral hypoxia-ischemia, and worse outcomes.
