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What Variables Correlate With Different Clinical Outcomes of Abusive Head Injury?
Sonia Ajmera1, Mustafa Motiwala1, Matt Weeks2
1College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Abusive head trauma (AHT) in children has severe outcomes. Pupillary exam, INR, and seizures are key predictors of death, stroke, and need for surgery in AHT cases.
Area of Science:
- Pediatric Traumatology
- Neurology
- Forensic Medicine
Background:
- Abusive head trauma (AHT) encompasses a wide range of injury severities, with outcomes consistently worse than accidental trauma.
- Limited research exists on the specific outcomes associated with AHT.
Purpose of the Study:
- To identify demographic and clinical variables linked to distinct outcomes in abusive head trauma (AHT).
Main Methods:
- A retrospective analysis of 305 children diagnosed with AHT between 2009 and 2017.
- Outcomes modeled included death or massive hemispheric stroke, any stroke, and need for neurosurgery.
- Bivariate and multivariable analyses were used to correlate demographic and clinical data with outcomes.
Main Results:
- Pupillary exam abnormalities and elevated admission INR were significantly associated with death or massive hemispheric stroke.
- Pupillary abnormalities, seizures, hematocrit, and INR correlated with stroke occurrence.
- Seizures were associated with the need for neurosurgical intervention.
Conclusions:
- Several demographic and clinical factors are associated with specific, clinically relevant outcomes in abusive head trauma.
- These findings can aid in predicting AHT outcomes and guiding clinical management.
Background:
The spectrum of injury severity for abusive head trauma (AHT) severity is broad, but outcomes are unequivocally worse than accidental trauma. There are few publications that analyze different outcomes of AHT.
Objective:
To determine variables associated with different outcomes of AHT.
Methods:
Patients were identified using our AHT database. Three different, but not mutually exclusive, outcomes of AHT were modeled: (1) death or hemispheric stroke (diffuse loss of grey-white differentiation); (2) stroke(s) of any size; and (3) need for a neurosurgical operation. Demographic and clinical variables were collected and correlations to the 3 outcomes of interest were identified using bivariate and multivariable analysis.
Results:
From January 2009 to December 2017, 305 children were identified through a prospectively maintained AHT database. These children were typically male (60%), African American (54%), and had public or no insurance (90%). A total of 29 children (9.5%) died or suffered a massive hemispheric stroke, 57 (18.7%) required a neurosurgical operation, and 91 (29.8%) sustained 1 or more stroke. Death or hemispheric stroke was statistically associated with the pupillary exam (odds ratio [OR] = 45.7) and admission international normalized ratio (INR) (OR = 17.3); stroke was associated with the pupillary exam (OR = 13.2), seizures (OR = 14.8), admission hematocrit (OR = 0.92), and INR (9.4), and need for surgery was associated with seizures (OR = 8.6).
Conclusion:
We have identified several demographic and clinical variables that correlate with 3 clinically applicable outcomes of abusive head injury.
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