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Understanding the Five-Year Outcomes of Abusive Head Trauma in Children: A Retrospective Cohort Study
Jaimi Manfield1, Karen Oakley2,3, Julie-Anne Macey2
1The University of Notre Dame Australia, Darlinghurst, NSW, Australia.
Insights
Children surviving abusive head trauma (AHT) often experience worsening long-term disabilities, including behavioral and vision problems. Continued follow-up is crucial for all AHT survivors, irrespective of initial recovery signs.
Area of Science:
- Pediatrics
- Neurology
- Child Development
Background:
- Abusive head trauma (AHT) poses significant risks to children's long-term health.
- Understanding outcomes is vital for providing appropriate support and services to survivors.
Purpose of the Study:
- To examine the long-term medical and developmental outcomes of children surviving AHT.
- To assess changes in outcomes from acute discharge to five years post-injury.
Main Methods:
- Retrospective study of 55 children treated for AHT at The Children's Hospital at Westmead.
- Global outcomes assessed using the Kings Outcome Scale of Childhood Head Injury (KOSCHI).
- Specific impairments tracked included behavioral, vision, motor, communication, and seizures.
Main Results:
- Five years post-AHT, 81.8% had moderate to severe disabilities, an increase from 64.5% at discharge.
- Common impairments included behavioral problems (53%), vision impairment (44%), and motor difficulties (26%).
- KOSCHI scores at follow-up were poorly predicted by acute discharge scores, with many worsening.
Conclusions:
- Long-term outcomes for AHT survivors frequently involve significant and potentially worsening disabilities.
- All children with AHT require ongoing, long-term follow-up care.
- Early recovery indicators do not reliably predict long-term prognosis.
Abstract:
Understanding the long-term medical and developmental outcomes for children who survive abusive head trauma (AHT) is important to ensure necessary supports and services are available. This study examined the retrospective global and specific medical and developmental outcomes of 55 children with AHT who were treated at The Children's Hospital at Westmead. Global outcomes were assessed using the Kings Outcome Scale of Childhood Head Injury (KOSCHI). Five years post-injury, one child had died and two had made a complete recovery. Forty-five children (81.8%) had a moderate or severe disability, an increase from 64.5% at acute discharge. At follow-up, the main impairments were behavioral problems (53%), vision impairment (44%), fine motor difficulties (26%), gross motor problems (26%), communication problems (24%) and 16% had seizures. A Spearman's Rank correlation revealed that only 41% of variance in KOSCHI scores five years post-injury could be accounted for KOSCHI scores at the time of acute discharge (rs(55) = 0.638, p < .001), and many children's presentation was worse at follow-up. Therefore, all children presenting with AHT need long term follow up regardless of early indications of good recovery.
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