Disability and visual outcomes following suspected abusive head trauma in children under 2 years
Juliana Wright1, Sally Painter2, Sheethal Sujayeendra Kodagali3
1Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK juliana.wright@ouh.nhs.uk.
Insights
Abusive head trauma (AHT) in young children leads to significant disability and visual impairment. Retinal hemorrhages correlate with poorer outcomes, and disability may not be fully evident at discharge.
Area of Science:
- Pediatric Ophthalmology
- Neurology
- Child Abuse Pediatrics
Background:
- Suspected abusive head trauma (AHT) is a critical concern in pediatric medicine.
- Understanding long-term disability and visual outcomes is essential for affected children.
Purpose of the Study:
- To report disability and visual outcomes in children under two years with suspected AHT.
- To correlate initial injury findings with long-term functional status.
Main Methods:
- Retrospective case series of 44 children (≤24 months) with suspected AHT (1995-2017).
- Assessed disability using King's Outcome Score of Childhood Head Injury (KOSCHI).
- Recorded retinal hemorrhage score (RHS) and visual outcome scores.
Main Results:
- 98% had subdural and 93% had retinal hemorrhages at presentation.
- 61% experienced moderate-to-severe disability at discharge; 35% had visual impairment.
- Higher RHS correlated with greater disability and poorer visual function.
Conclusions:
- Suspected AHT results in high rates of disability and visual impairment.
- Retinal changes are linked to severity of disability and visual deficits.
- Disability extent may be underestimated at discharge, affecting prognosis and follow-up planning.
Aim:
To report disability and visual outcomes following suspected abusive head trauma (AHT) in children under 2 years.
Methods:
We present a retrospective case series (1995-2017) of children with suspected AHT aged ≤24 months. King's Outcome Score of Childhood Head Injury (KOSCHI) was used to assess disability outcomes at hospital discharge and at follow-up. The study used a retinal haemorrhage score (RHS) to record findings at presentation and a visual outcome score at follow-up.
Results:
We included 44 children (median age 16 weeks). At presentation, 98% had a subdural haemorrhage and 93% had a retinal haemorrhage. At discharge, 61% had moderate-to-severe disability, and 34% a good recovery. A higher RHS was observed in those with more disability (r=-0.54, p=0.0002). At follow-up, 14% had a worse KOSCHI score (p=0.055). 35% children had visual impairment, including 9% with no functional vision. Those with poorer visual function had a higher RHS (r=0.53, p=0.003). 28% attended mainstream school without support; 50% were in foster care or had been adopted, 32% lived with birth mother and 18% with extended family.
Conclusion:
It is known that injuries from suspected AHT result in high levels of morbidity; our cohort showed significant rates of disability and visual impairment. Those with higher disability at discharge and poorer visual function showed more significant retinal changes. The extent of disability was not always apparent at hospital discharge, impacting on provision of prognostic information and targeted follow-up.
