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Developmental Outcomes Following Abusive Head Trauma in Infancy: A Systematic Review
Cristina A Sarmiento1, Jordan M Wyrwa, Amy V Chambliss
1Departments of Pediatric Rehabilitation Medicine (Drs Sarmiento, Wyrwa, Chambliss, and Appel) and Pediatrics (Drs Chambliss and Appel), Children's Hospital Colorado, Aurora; Departments of Physical Medicine and Rehabilitation (Drs Sarmiento, Wyrwa, Chambliss, Appel, and Brenner and Ms Stearns-Yoder) and Psychiatry and Neurology (Dr Brenner), University of Colorado Anschutz School of Medicine, Aurora; Veterans Health Administration Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado (Ms Stearns-Yoder, Mr Hoffberg, and Dr Brenner); and Brandeis University, Waltham, Massachusetts (Mr Brenner).
Insights
This review identifies inconsistent methods for assessing developmental outcomes in abusive head trauma (AHT) survivors. Standardized approaches are needed to understand AHT
Area of Science:
- Pediatric neurology
- Developmental psychology
- Child abuse research
Background:
- Abusive head trauma (AHT) significantly impacts infant development, yet outcomes and effective interventions remain poorly understood.
- Existing research on AHT outcomes utilizes diverse assessment tools and methodologies, hindering comparative analysis.
- There is a critical need to identify standardized measures for evaluating developmental trajectories following AHT.
Conclusions:
- Significant variation in case ascertainment and outcome assessment limits the understanding of AHT's impact on development.
- The efficacy of interventions aimed at improving outcomes for AHT survivors cannot be reliably determined due to inconsistent methodologies.
- Adoption of consistent diagnostic and assessment approaches by researchers and clinicians is strongly recommended to advance the field.
Objective:
A systematic review of the literature was conducted to identify measures used to evaluate developmental outcomes after abusive head trauma (AHT), as well as describe outcomes among those with AHT, and explore factors and interventions influencing such outcomes.
Design:
This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The protocol is in PROSPERO, registration number CRD42020179592. On April 17, 2020, OVID Medline, Embase, OVID PsycINFO, Web of Science, CINAHL, Cochrane Library, and Google Scholar were searched (since inception). Inclusion criteria included original, peer-reviewed study data; AHT exposure; infants younger than 24 months at time of AHT; and evaluation of developmental outcomes. Reviewers independently evaluated studies for inclusion and assessed risk of bias using the Effective Public Health Practice Project quality assessment tool for quantitative studies. A descriptive synthesis approach was utilized as variability of study designs, follow-up periods, and outcome assessment tools precluded a meta-analytic approach.
Results:
Fifty-nine studies were included; 115 assessment tools were used to evaluate developmental outcomes; and 42 studies examined factors influencing outcomes. Two studies evaluated interventions. Five percent of studies ( n = 3) were rated low risk of bias.
Conclusions:
Notable variation was observed in terms of case ascertainment criteria. Developmental outcomes after AHT have been assessed in a manner that limits understanding of how AHT impacts development, as well as the efficacy of interventions intended to improve outcomes. Researchers and clinicians are encouraged to adopt consistent diagnostic and assessment approaches.
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