Age-related mortality in abusive head trauma

Area of Science:

• Pediatrics
• Forensic Pathology
• Epidemiology

Background:

• Abusive head trauma (AHT) is a significant cause of injury and mortality in infants and toddlers.
• Injury patterns and associated mortality risks differ between infants and older children.
• The impact of age on mortality risk in AHT requires further investigation.

Purpose of the Study:

• To evaluate the association between age at diagnosis and mortality risk in children with abusive head trauma (AHT).
• To compare injury characteristics and mortality rates between different age groups of children with AHT.
• To determine if the age-related mortality risk in AHT is unique compared to accidental head trauma.

Main Methods:

• Retrospective analysis of AHT hospitalizations from the Kid's Inpatient Claims Database (2000-2012).
• Inclusion of an accidental head trauma cohort for comparative analysis.
• Nested multivariable logistic regression to assess the association between age and mortality.

Main Results:

• Children aged 2-4 years had a higher mortality rate (22%) compared to those younger than 2 years (10%) in AHT cases (aOR, 1.6).
• Specific injuries like subarachnoid hemorrhage, cerebral edema, and retinal hemorrhage were linked to increased mortality.
• While younger children (<2 years) had comparable AHT and accidental trauma mortality, older children (2-4 years) had significantly higher mortality with AHT (aOR, 3.3).

Conclusions:

• Age at diagnosis is a critical factor influencing mortality risk in pediatric abusive head trauma.
• Distinct injury profiles are observed in infants versus toddlers with AHT, correlating with different mortality risks.
• The elevated mortality risk in older children (2-4 years) with AHT is specific to abuse and underscores the need for heightened awareness and timely diagnosis.