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Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Educational paper: Abusive Head Trauma part I. Clinical aspects
Tessa Sieswerda-Hoogendoorn1, Stephen Boos, Betty Spivack
1Section Forensic Paediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands. T.Sieswerda@amc.uva.nl
Insights
Abusive Head Trauma (AHT), a common cause of childhood neurotrauma, often results from impact and shaking. Early diagnosis and a structured approach are crucial due to its high mortality and severe disability rates in affected children.
Area of Science:
- Pediatrics
- Neurology
- Child Abuse Research
Background:
- Abusive Head Trauma (AHT) is a leading cause of non-accidental childhood neurotrauma, previously known as shaken baby syndrome.
- AHT encompasses injuries from both shaking and impact, affecting approximately 14-40 infants per 100,000 annually.
- Mortality rates range from 15-23%, with survivors facing significant long-term neurological disabilities.
Purpose of the Study:
- To highlight the importance of recognizing AHT in pediatric neurotrauma cases.
- To emphasize the need for a structured diagnostic approach for clinicians.
- To underscore the challenges in diagnosis due to non-spontaneous reporting by caregivers.
Main Methods:
- Review of clinical findings associated with AHT.
- Analysis of incidence and outcomes in affected children.
- Identification of diagnostic indicators, including apnea as a distinguishing feature from accidental injury.
Main Results:
- AHT presents with diverse neurological signs, often with subdural hematomas as a common finding.
- Survivors experience significant disability, with up to half exhibiting IQs below the 10th percentile.
- Apnea is identified as a key differentiator between AHT and accidental trauma.
Conclusions:
- A high index of suspicion for AHT is warranted in children with neurological symptoms, especially when trauma history is minimal.
- Clinicians require comprehensive knowledge of AHT's signs, symptoms, risk factors, and diagnostic workup.
- A structured approach, akin to managing other lethal diseases, is essential for accurate AHT diagnosis and management.
Unlabelled:
Abusive Head Trauma (AHT) refers to the combination of findings formerly described as shaken baby syndrome. Although these findings can be caused by shaking, it has become clear that in many cases there may have been impact trauma as well. Therefore a less specific term has been adopted by the American Academy of Pediatrics. AHT is a relatively common cause of childhood neurotrauma with an estimated incidence of 14-40 cases per 100,000 children under the age of 1 year. About 15-23% of these children die within hours or days after the incident. Studies among AHT survivors demonstrate that approximately one-third of the children are severely disabled, one-third of them are moderately disabled and one-third have no or only mild symptoms. Other publications suggest that neurological problems can occur after a symptom-free interval and that half of these children have IQs below the 10th percentile. Clinical findings are depending on the definitions used, but AHT should be considered in all children with neurological signs and symptoms especially if no or only mild trauma is described. Subdural haematomas are the most reported finding. The only feature that has been identified discriminating AHT from accidental injury is apnoea.
Conclusion:
AHT should be approached with a structured approach, as in any other (potentially lethal) disease. The clinician can only establish this diagnosis if he/she has knowledge of the signs and symptoms of AHT, risk factors, the differential diagnosis and which additional investigations to perform, the more so since parents seldom will describe the true state of affairs spontaneously.
