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Abusive Head Trauma and a Delay in Presentation for Care
Juliana M Kennedy1, Jihyun Ma2, Elizabeth R Lyden3
1From the New York University School of Medicine, New York, NY.
Insights
Delayed presentation for care is more common in children with abusive head trauma (AHT) compared to accidental head trauma. This delay should prompt clinicians to consider abusive injury in their diagnosis.
Area of Science:
- Pediatric critical care medicine
- Child abuse and neglect research
- Trauma and injury prevention
Background:
- Abusive head trauma (AHT) is a leading cause of mortality in young children.
- Delayed presentation for medical care is a potential indicator of AHT, but requires further investigation.
- Understanding presentation delays can aid in early diagnosis and intervention for AHT.
Purpose of the Study:
- To compare the time to presentation for care between children diagnosed with AHT and those with accidental head trauma.
- To identify factors associated with delayed presentation in pediatric head injuries.
Main Methods:
- Retrospective study of children under 6 years old admitted to a pediatric intensive care unit with acute head injury (2013-2017).
- Analysis of symptom onset to presentation duration and head injury nature (abusive vs. accidental).
- Statistical comparison of presentation times, patient demographics, and outcomes between AHT and accidental head trauma groups.
Main Results:
- Children with AHT were significantly more likely to present over 30 minutes after symptom onset (P = 0.0015).
- AHT patients were younger (median 4 vs. 31 months) and more likely to receive Medicaid.
- AHT cases had longer ICU stays (median 11 vs. 3 days) and lower discharge home rates (38% vs. 84%).
Conclusions:
- Delayed presentation for medical care is significantly associated with abusive head trauma in children.
- Clinicians should consider AHT in cases of delayed presentation following head injury.
- Early recognition of delayed care can be crucial for timely diagnosis and management of AHT.
Objectives:
Abusive head trauma (AHT) is the leading cause of death from trauma in children less than 2 years of age. A delay in presentation for care has been reported as a risk factor for abuse; however, there has been limited research on this topic. We compare children diagnosed with AHT to children diagnosed with accidental head trauma to determine if there is a delay in presentation.
Methods:
We retrospectively studied children less than 6 years old who had acute head injury and were admitted to the pediatric intensive care unit at a pediatric hospital from 2013 to 2017. Cases were reviewed to determine the duration from symptom onset to presentation to care and the nature of the head injury (abusive vs accidental).
Results:
A total of 59 children met inclusion criteria. Patients who had AHT were significantly more likely to present to care more than 30 minutes after symptom onset (P = 0.0015). Children who had AHT were more likely to be younger (median, 4 vs 31 months; P < 0.0001) and receive Medicaid (P < 0.0001) than those who had accidental head trauma. Patients who had AHT were more likely to have a longer length of stay (median, 11 vs 3 days; P < 0.0001) and were less likely to be discharged home than patients who had accidental head trauma (38% vs 84%; P = 0.0005).
Conclusions:
Children who had AHT were more likely to have a delayed presentation for care as compared with children whose head trauma was accidental. A delay in care should prompt clinicians to strongly consider a workup for abusive injury.
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