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Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study
Claudia Díaz-Olavarrieta1, Corina A García-Piña, Arturo Loredo-Abdala
1National Institute of Public Health, Research Center on Health Population, Mexico City, Mexico.
Insights
In Mexico City, 11% of pediatric head trauma cases were abusive head trauma (AbHT). Risk factors included unintended teen pregnancies and paternal substance abuse, with AbHT infants experiencing severe outcomes.
Area of Science:
- Pediatric Traumatology
- Child Abuse Pediatrics
- Forensic Medicine
Background:
- Abusive head trauma (AbHT) is a significant cause of morbidity and mortality in infants and young children.
- Understanding the prevalence and characteristics of AbHT is crucial for early identification and intervention.
Purpose of the Study:
- To determine the prevalence, clinical signs, and demographic/family characteristics of children with abusive head trauma (AbHT).
- To illustrate the specific features of AbHT in children treated at a tertiary care hospital in Mexico City.
Main Methods:
- A cross-sectional descriptive study was conducted at a tertiary care referral center.
- Medical records of children under 5 with head trauma were reviewed for clinical, neurological, radiological, and laboratory data.
- A standardized questionnaire assessed child abuse and neglect in parents.
Main Results:
- Of 120 children with head trauma, 13 (11%) were classified as AbHT, while 107 (89%) had accidental head injury (AcHI).
- AbHT cases involved younger infants (mean age 8 months) and were more likely to be female, from unintended pregnancies, with younger mothers (17-19), and paternal alcohol abuse.
- AbHT children had higher mortality (38%), greater neurological/respiratory compromise, and specific injuries like subdural/epidural hematomas and retinal hemorrhages.
Conclusions:
- Abusive head trauma (AbHT) accounted for 11% of pediatric head trauma cases at the studied tertiary care hospital.
- Unintended pregnancies among teen mothers and paternal substance abuse were associated with AbHT.
- AbHT cases demonstrated severe clinical presentations and poorer survival rates.
Objectives:
Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population.
Methods:
This is a cross-sectional descriptive study of infants and children under 5, who suffered head trauma and were admitted to the National Pediatrics Institute in Mexico City, a tertiary care referral center. We reviewed medical records and extracted data on clinical and neurological signs and symptoms, fundus, radiological (long bones, thorax, CAT scan), and laboratory tests. We administered a standardized questionnaire assessing child abuse and neglect to the parents of the children included in the study.
Results:
One hundred and twenty children, under 5 presenting with head trauma, were recruited, 13 (11%) were considered abusive head trauma (AbHT) and 107 (89%) were diagnosed as accidental head injury (AcHI). The AbHT group comprised younger infants (mean age 8 months) and the AcHI group included toddlers about an average of 25 months. To account for this significant age difference, we performed a comparison of age matched cases. The children in the AbHT were more likely to be female, the result of the first unintended pregnancy and the children of younger mothers (17-19). Mothers in this group had attended fewer than 5 prenatal care visits and fathers had a history of alcohol abuse. Five (38%) of the 13 AbHT children did not survive their injuries and overall showed greater neurological and respiratory compromise, increased prothrombin time (PT), and lower hematocrit values. The most common intracranial injuries suffered by children in the AbHT group were subdural/epidural hematoma and parenchymal/subarachnoid hemorrhage. Retinal hemorrhage was the most frequent ocular injury.
Conclusions:
In a tertiary care children's hospital, 11% of the children presenting with head trauma, were considered of abusive origin. Unintended pregnancy among teen mothers and substance abuse in the father were associated with abusive head trauma in this descriptive study.
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