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Delay in Arrival to Care in Perpetrator-Identified Nonaccidental Head Trauma: Observations and Outcomes
Sudhakar Vadivelu1, Debra Esernio-Jenssen2, Harold L Rekate1
1The Cushing Neuroscience Institutes and the Department of Neurosurgery, Hofstra North Shore-Long Island Jewish School of Medicine at Cohen Children's Medical Center and the North Shore-Long Island Jewish Health System, Manhasset, New York, USA.
Insights
Moderate delays in seeking care for nonaccidental head trauma (NAHT) in children correlate with worse outcomes. Early or very late presentation may be associated with better results, but moderate delays are concerning for child head injury prognosis.
Area of Science:
- Pediatric Traumatology
- Child Abuse Forensics
- Neurology
Background:
- Nonaccidental head trauma (NAHT) poses a severe mortality risk to young children within 24 hours of presentation.
- The timing of medical intervention is a critical factor influencing patient outcomes in pediatric head injuries.
Purpose of the Study:
- To investigate the relationship between the delay in seeking medical attention and patient outcomes in children with nonaccidental head trauma.
- To analyze the impact of different delay intervals on mortality and functional recovery using the King's Outcome Scale for Childhood Head Injury (KOSCHI).
Main Methods:
- A 10-year retrospective review of 48 pediatric cases of NAHT treated at a tertiary children's hospital.
- Categorization of injury-to-hospital arrival intervals: <6 hours (no delay), 6-12 hours (moderate delay), >12 hours (severe delay).
- Correlation of clinical presentation (Glasgow Coma Scale - GCS, extracranial injuries) and KOSCHI scores with delay categories.
Main Results:
- Children were predominantly male and under 3 years old.
- 61% of patients presented with moderate or severe delay (>6 hours).
- Lower arrival GCS scores and presence of extracranial injuries were linked to worse outcomes. Patients presenting without delay or with severe delay had higher KOSCHI scores. Four of six fatalities occurred after moderate delay.
Conclusions:
- A moderate delay (6-12 hours) in seeking medical care for NAHT appears associated with poorer patient outcomes compared to earlier or later presentations.
- The timing of presentation significantly impacts the prognosis for children suffering nonaccidental head trauma.
Background:
Children who sustained nonaccidental head trauma (NAHT) are at severe risk for mortality within the first 24 hours after presentation.
Objective:
Extent of delay in seeking medical attention may be related to patient outcome.
Methods:
A 10-year, single-institution, retrospective review of 48 cases treated at a large tertiary Children's Hospital reported to the New York State Central Registrar by the child protection team was conducted. The perpetrator was identified in 28 cases on the basis of confession or conviction. The medical and legal records allowed for identification of time of injury and the interval between injury and arrival to the hospital; this information was categorized as follows: <6 hours (without delay); 6-12 hours (moderate delay); and >12 hours (severe delay). The King's Outcome Scale for Childhood Head Injury (KOSCHI) score was recorded for each case.
Results:
All children were 3 years of age or younger (2.1-34 months) and predominantly male (68%; 19/28). On arrival, 61% of patients (17/28) presented with moderate or severe delay. A low arrival Glasgow Coma Scale (GCS) score (P < 0.0001) and extracranial injuries (P < 0.0061) correlated with worse clinical patient outcomes. Patients with an arrival GCS score <7 predominantly arrived without delay or with moderate delay. Patients presenting without delay or with severe delay were more likely to have a higher KOSCHI outcome score on discharge (P < 0.0426). Four of the 6 patients who died presented after moderate delay.
Conclusion:
Patients presenting to medical care 6-12 hours after NAHT (moderate delay) appeared to have worse outcomes than those presenting earlier or later.
