Related Experiment Video
Updated: Jan 2, 2026
Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study
Franz E Babl1,2,3, Helena Pfeiffer1,2, Patrick Kelly4,5
1Emergency department, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Abusive head trauma (AHT) in children presents with distinct clinical features, including loss of consciousness and seizures. Early identification of suspected AHT is crucial due to increased risks of severe outcomes and mortality.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse and Neglect
- Forensic Pediatrics
Background:
- Abusive head trauma (AHT) is a severe form of child maltreatment with significant morbidity and mortality.
- Accurate and timely diagnosis of AHT in emergency settings is critical for intervention and improving outcomes.
Purpose of the Study:
- To characterize clinical presentations of suspected abusive head trauma (AHT) in children.
- To compare the features and outcomes of confirmed AHT cases with non-AHT cases.
Main Methods:
- A prospective, multicentre cohort study analyzed head-injured children (<18 years) across five Australian and New Zealand centers.
- Suspected AHT cases were identified by emergency department clinicians; confirmed through multidisciplinary review.
- Statistical analysis compared presenting features and outcomes using odds ratios.
Main Results:
- Abusive head trauma (AHT) was suspected in 0.5% of head-injured children.
- Confirmed AHT cases were younger (median 1.4 years) than non-AHT cases (median 4.1 years).
- Confirmed AHT cases showed significantly higher odds of loss of consciousness, scalp hematomas, seizures, low Glasgow Coma Scale, abnormal neuroimaging, intensive care admission, and mortality.
Conclusions:
- Emergency department presentations of suspected and confirmed AHT cases exhibit specific clinical indicators.
- Children with confirmed AHT face substantially elevated risks for severe neuroimaging findings, intensive care needs, and death.
Aim:
Abusive head trauma (AHT) is associated with high morbidity and mortality. We aimed to describe characteristics of cases where clinicians suspected AHT and confirmed AHT cases and describe how they differed.
Methods:
This was a planned secondary analysis of a prospective multicentre cohort study of head injured children aged <18 years across five centres in Australia and New Zealand. We identified cases of suspected AHT when emergency department clinicians raised suspicion on a clinical report form or based on research assistant-assigned epidemiology codes. Cases were categorised as AHT positive, negative and indeterminate after multidisciplinary review. Suspected and confirmed AHT and non-AHT cases were compared using odds ratios with 95% confidence intervals.
Results:
AHT was suspected in 70 of 13 371 (0.5%) head-injured children. Of these, 23 (32.9%) were categorised AHT positive, 18 (25.7%) AHT indeterminate and 29 (27.1%) AHT negative. Median age was 0.8 years in suspected, 1.4 years in confirmed AHT and 4.1 years in non-AHT cases. Odds ratios (95% confidence interval) for presenting features and outcomes in confirmed AHT versus non-AHT were: loss of consciousness 2.8 (1.2-6.9), scalp haematoma 3.9 (1.7-9.0), seizures 12.0 (4.0-35.5), Glasgow coma scale ≤12 30.3 (11.8-78.0), abnormal neuroimaging 38.3 (16.8-87.5), intensive care admission 53.4 (21.6-132.5) and mortality 105.5 (22.2-500.4).
Conclusions:
Emergency department presentations of children with suspected and confirmed AHT had higher rates of loss of consciousness, scalp haematomas, seizures and low Glasgow coma scale. These cases were at increased risk of abnormal computed tomography scans, need for intensive care and death.
More Related Videos
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
07:01A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025