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Published on: June 30, 2023
Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study
Franz E Babl1,2,3, Helena Pfeiffer1,2, Stuart R Dalziel4,5
1Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Intentional head injuries (HI) in children are infrequent, with caregivers and peers being the most common perpetrators. Assaults by caregivers result in particularly severe injuries, including clinically important traumatic brain injury (ciTBI).
Area of Science:
- Pediatrics
- Traumatology
- Public Health
Background:
- Research on head injury (HI) in young children is extensive, but less is known about intentional HI in older children and by non-caregiver perpetrators.
- Understanding the epidemiology and demographics of intentional HI is crucial for developing targeted prevention strategies.
Purpose of the Study:
- To describe the epidemiology, demographics, and severity of intentional head injuries in children.
- To identify the perpetrators and injury patterns associated with intentional HI in a pediatric population.
Main Methods:
- A secondary analysis of a prospective multicentre cohort study involving 10 emergency departments in Australia and New Zealand.
- Inclusion criteria: children under 18 years with head injuries. Data collected included injury epidemiology codes, demographics, and clinical information.
- Clinically important traumatic brain injury (ciTBI) was defined as HI leading to death, neurosurgery, prolonged intubation, or prolonged hospital admission with abnormal CT scan.
Main Results:
- Intentional injuries were identified in 1.8% of 20,137 head-injured children.
- Caregivers were the most frequent perpetrators (27.7%), followed by peers (26.1%) and siblings (12.6%).
- Victims of caregiver assault were significantly younger (<2 years: 75.7%) compared to other perpetrator groups (4.9%). The rate of ciTBI was highest for caregiver assaults (22.3%) compared to peer assaults (3.1%) or other perpetrators (0.0%).
Conclusions:
- Intentional head injury in children is infrequent but significant.
- Caregivers and peers are the most common perpetrators of intentional HI.
- Injuries inflicted by caregivers are associated with a higher severity and risk of clinically important traumatic brain injury (ciTBI).
Objective:
Although there is a large body of research on head injury (HI) inflicted by caregivers in young children, little is known about intentional HI in older children and inflicted HI by perpetrators other than carers. Therefore, we set out to describe epidemiology, demographics and severity of intentional HIs in childhood.
Methods:
A planned secondary analysis of a prospective multicentre cohort study was conducted in 10 EDs in Australia and New Zealand, including children aged <18 years with HIs. Epidemiology codes were used to prospectively code the injuries. Demographic and clinical information including the rate of clinically important traumatic brain injury (ciTBI: HI leading to death, neurosurgery, intubation >1 day or admission ≥2 days with abnormal computed tomography [CT]) was descriptively analysed.
Results:
Intentional injuries were identified in 372 of 20 137 (1.8%) head-injured children. Injuries were caused by caregivers (103, 27.7%), by peers (97, 26.1%), by siblings (47, 12.6%), by strangers (35, 9.4%), by persons with unknown relation to the patient (21, 5.6%), other intentional injuries (8, 2.2%) or undetermined intent (61, 16.4%). About 75.7% of victims of assault by caregivers were <2 years, whereas in other categories, only 4.9% were <2 years. Overall, 66.9% of victims were male. Rates of CT performance and abnormal CT varied: assault by caregivers 68.9%/47.6%, by peers 18.6%/27.8%, by strangers 37.1%/5.7%. ciTBI rate was 22.3% in assault by caregivers, 3.1% when caused by peers and 0.0% with other perpetrators.
Conclusions:
Intentional HI is infrequent in children. The most frequently identified perpetrators are caregivers and peers. Caregiver injuries are particularly severe.
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