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The Presence of Anemia in Children with Abusive Head Trauma
Katelyn M Even1, Subramanian Subramanian2, Rachel P Berger3
1Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Insights
Children with abusive head trauma (AHT) are more likely to present with anemia and severe brain injury. Anemia in AHT cases may indicate a higher risk of poor outcomes.
Area of Science:
- Pediatric Traumatology
- Hematology
- Neurology
Background:
- Anemia is a common finding in pediatric trauma.
- The association between anemia and abusive head trauma (AHT) requires further investigation.
- Understanding the incidence and impact of anemia in different forms of pediatric TBI is crucial.
Purpose of the Study:
- To determine the incidence of anemia in children under 3 years with AHT, noninflicted traumatic brain injury (TBI), and physical abuse without AHT.
- To evaluate the effect of anemia on clinical outcomes in these pediatric patient groups.
- To compare the severity of intracranial hemorrhage (ICH) and its relation to anemia across different injury types.
Main Methods:
- Retrospective, single-center cohort study of children under 3 years.
- Inclusion criteria: AHT (n=75), noninflicted TBI (n=77), physical abuse without AHT (n=60).
- Primary outcome: anemia at presentation. Secondary outcomes: unfavorable outcome (Glasgow Outcome Scale 1-3), ICH volume.
Main Results:
- Anemia incidence was significantly higher in AHT (47.3%) compared to noninflicted TBI (15.6%) and physical abuse (10%).
- AHT patients exhibited larger ICH volumes and greater ICH/total brain volume percentages.
- Anemia was associated with AHT and increased ICH volume in univariate analysis; it was also linked to unfavorable outcomes.
Conclusions:
- Abusive head trauma is strongly associated with a higher likelihood of presenting with anemia and severe traumatic intracranial hemorrhage.
- Anemia in children with AHT may serve as an indicator for increased risk of adverse outcomes.
- Further research is warranted to elucidate the causal relationship and clinical implications of anemia in pediatric abusive head trauma.
Objectives:
To evaluate the incidence of anemia in patients with abusive head trauma (AHT), noninflicted traumatic brain injury (TBI), and physical abuse without AHT and the effect of anemia on outcome.
Study Design:
In a retrospective, single-center cohort study, we included children under the age of 3 years diagnosed with either AHT (n = 75), noninflicted TBI (n = 77), or physical abuse without AHT (n = 60) between January 1, 2014, and December 31, 2016. Neuroimaging was prospectively analyzed by pediatric neuroradiologists. Primary outcome was anemia at hospital presentation. Secondary outcomes included unfavorable outcome at hospital discharge, defined as a Glasgow Outcome Scale between 1 and 3, and intracranial hemorrhage (ICH) volume.
Results:
Patients with AHT had a higher rate of anemia on presentation (47.3%) vs noninflicted TBI (15.6%) and physical abuse without AHT (10%) (P < .001). Patients with AHT had larger ICH volumes (33.3 mL [10.1-76.4 mL] vs 1.5 mL [0.6-5.2 mL] ; P < .001) and greater ICH/total brain volume percentages than patients with noninflicted TBI (4.6% [1.4-8.2 %] vs 0.2% [0.1-0.7%]; P < .001). Anemia was associated with AHT (OR, 4.7; 95% CI, 2.2-10.2) and larger ICH/total brain volume percentage (OR, 1.1; 95% CI, 1.1-1.2) in univariate analysis. Unfavorable outcome at hospital discharge was associated with anemia (OR, 4.4; 95% CI, 1.6-12.6) in univariate analysis, but not after controlling for covariates.
Conclusions:
Patients with AHT were more likely to present to the hospital with anemia and increased traumatic ICH volume than patients with noninflicted TBI or physical abuse without AHT. Children with anemia and AHT may be at increased risk for an unfavorable outcome.
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