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Child Abuse and Deformational Plagiocephaly in a West Texas Hospital System
Preston D'Souza1, Keith A Hanson1, Pranati Pillutla1
1School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, United States.
Insights
Deformational plagiocephaly (DP) is not a reliable predictor of child neglect or nonaccidental trauma (NAT). This study found no significant association between DP and abuse, suggesting other factors are more indicative of child maltreatment.
Area of Science:
- Pediatric Medicine
- Child Abuse and Neglect
- Radiology
Background:
- Deformational plagiocephaly (DP) is a common condition in infants.
- Assessing DP's predictive value for child neglect and nonaccidental trauma (NAT) is crucial for early intervention.
- Understanding the prevalence of DP and NAT in rural populations is important for targeted healthcare strategies.
Purpose of the Study:
- To evaluate the predictive value of deformational plagiocephaly (DP) for neglect and nonaccidental trauma (NAT) in children.
- To determine the prevalence of DP and NAT within a predominantly rural pediatric patient population.
- To investigate potential correlations between DP severity (CVAI) and characteristics of abuse or neglect.
Main Methods:
- Retrospective chart review of hospitalized patients diagnosed with NAT and/or neglect (2012-2018).
- Inclusion criteria: children under 4 years old with legible head CT or MRI.
- DP assessment using cranial vault asymmetry index (CVAI) and cranial index from neuroimaging; statistical analysis using Wilcoxon's rank-sum and Fisher's exact tests.
Main Results:
- The prevalence of DP in the combined NAT and neglect cohort was 21%, similar to the general population.
- No statistically significant difference in DP prevalence was found between children with a history of NAT (p > 0.1) or neglect (p > 0.1).
- No correlation was observed between CVAI and the characteristics of initial presentation or trauma history in either NAT or neglect groups.
Conclusions:
- Deformational plagiocephaly is not a significant predictor of child abuse or neglect.
- The severity of DP does not correlate with the severity of trauma history or initial presentation in abused children.
- Further research is needed to identify unique and subtle predictive factors for child abuse and neglect.
Abstract:
Background The aim of this study was to assess deformational plagiocephaly's (DP) predictive value in neglect and physical abuse (nonaccidental trauma [NAT]) within the pediatric population. In addition, we sought to characterize the prevalence of DP and NAT for our hospital's mostly rural catchment area. Methods Data on hospitalized patients diagnosed with NAT and/or neglect between 2012 and 2018 were collected via retrospective chart review. All enrolled children were younger than the age of 4 years at the time of diagnosis, and those without legible head computed tomographies or magnetic resonance images during their initial hospitalization were excluded. Utilizing neuroimaging, we calculated the cranial vault asymmetry index (CVAI) and cranial index for each patient to assess for DP. Differences between the two groups were assessed using Wilcoxon's rank-sum test for continuous variables and Fisher's exact test for categorical variables. A p -value of 0.05 or less was considered statistically significant. All analyses were conducted using SAS 9.4 (Cary, North Carolina, United States). Results The prevalence of DP within the combined cohort of NAT and neglect patients is 21%, similar to that reported in the literature for the general population (20-50%). There was no significance between the prevalence of DP and a history of NAT ( p > 0.1) or neglect ( p > 0.1). Furthermore, there was no correlation between CVAI and characteristics of initial presentation or history of trauma for either NAT ( p -values: 0.359 and 0.250, respectively) or neglect groups ( p -values: 0.116 and 0.770, respectively). Conclusion While there are many limitations to this study, our results suggest that abused children are no more likely to have history of DP than the general population, and the degree of DP is not associated with severity of trauma history or initial presentation. We hope the results of this study promote future investigations for unique and subtle predictive factors of child abuse/neglect.