Related Experiment Video
Updated: Feb 16, 2026
Standard Operating Procedure for Lyssavirus Surveillance of the Bat Population in Taiwan
Published on: August 27, 2019
Pediatric abusive head trauma in Taiwan: clinical characteristics and risk factors associated with mortality
An-Lun Wu1,2, Lai-Chu See3,4, Shao-Hsuan Hsia2,5
1Department of Ophthalmology, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Rd, Taoyuan, Taiwan, 33375.
Insights
Abusive head trauma (AHT) in children is linked to specific risk factors for mortality, including respiratory distress, vomiting, macular retinoschisis, and subarachnoid hemorrhage. Early ophthalmologic exams are crucial for diagnosing AHT and predicting outcomes.
Area of Science:
- Pediatric Medicine
- Forensic Pathology
- Ophthalmology
Background:
- Abusive head trauma (AHT) is a severe form of child abuse with significant morbidity and mortality.
- Understanding the clinical characteristics and risk factors for mortality in AHT is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To describe the clinical features of AHT cases in Taiwan.
- To identify independent risk factors associated with in-hospital mortality in children diagnosed with AHT.
Main Methods:
- A retrospective review of children diagnosed with AHT between January 1, 2000, and October 31, 2015.
- Analysis of demographic data, clinical presentations, retinal findings, and radiologic evidence.
- Multivariable logistic regression was employed to determine factors predicting in-hospital mortality.
Main Results:
- Of 75 AHT cases, 92% exhibited retinal hemorrhages, often extensive and multi-layered.
- Macular retinoschisis was present in 26.7% of cases.
- In-hospital mortality was 13.3%. Key mortality predictors included respiratory distress/apnea (aOR=22.46), vomiting (aOR=11.94), macular retinoschisis (aOR=8.9), and subarachnoid hemorrhage (aOR=15.17).
Conclusions:
- Respiratory distress or apnea, vomiting, subarachnoid hemorrhage, and macular retinoschisis are significant independent predictors of mortality in AHT.
- Comprehensive ophthalmologic examinations are essential for identifying intraocular injuries, aiding in the diagnosis of child abuse, and forecasting neurological outcomes.
Purpose:
To report the clinical characteristics of abusive head trauma (AHT) in Taiwan and identify the risk factors associated with mortality of these patients.
Methods:
Children with clinically diagnosed AHT from January 1, 2000, to October 31, 2015 were reviewed. The demographic data, clinical features, and associated retinal and radiologic findings were analyzed. The multivariable logistic regression model analysis was performed to identify the risk factors associated with in-hospital mortality.
Results:
A total of 75 children were included. The mean age was 7.31 ± 6.57 months (range, 1-36 months). Retinal hemorrhages were detected in 69 children with AHT (92%). The majority of retinal hemorrhages were characterized by hemorrhagic numbers higher than ten (74.7%), multi-layered (54.7%), and extension beyond the posterior pole to the peripheral retina (73.3%). Twenty children (26.7%) had macular retinoschisis. As a direct result of AHT, ten children died in the hospital (13.3%). Logistic regression showed that respiratory distress or apnea (adjusted odds ratio [OR] = 22.46; 95% confidence interval [CI], 2.24-225.33; P = .0082), vomiting (adjusted OR = 11.94; 95% CI, 1.31-108.403; P = .0276), retinal finding of macular retinoschisis (adjusted OR = 8.9; 95% CI, 1.01-78.65; P = .0493), and the presence of subarachnoid hemorrhage (SAH) (adjusted OR = 15.17; 95% CI, 1.40-64.84; P = .0255) were independently associated with mortality.
Conclusions:
Respiratory distress or apnea, vomiting, SAH, and macular retinoschisis are independently associated with mortality in abusive head trauma. A complete ophthalmologic examination with the immediate visualization of intraocular injury should be performed to clarify the likelihood of child abuse and predict a potential poor neurologic outcome.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:24Drug Toxicity: Risk factors
01:15Drug Abuse and Addiction: Pharmacological Phenomena
01:23Characteristics of Life
01:12Relative Risk
01:19Muscles that Move the Head
The bilateral sternocleidomastoid, or SCM, and the suprahyoid and infrahyoid muscles are significant head flexors. The SCM muscles originate at the sternum and clavicle and attach to the mastoid process of the temporal bone. The SCM contracts bilaterally to bend the head forward, whereas...