Abusive Head Trauma and a Delay in Presentation for Care

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.