Comparisons of characteristics and outcome between abusive head trauma and non-abusive head trauma in a pediatric
Yi-Ching Liu1, I-Chen Chen2, Hsin-Ling Yin3
1Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Insights
Abusive head trauma (AHT) in infants leads to worse outcomes than non-abusive head trauma (nAHT). Conscious change is a key indicator and risk factor for poor outcomes in AHT.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Infant injury prevention
Background:
- Abusive head trauma (AHT) is a leading cause of infant death from traumatic brain injury (TBI).
- Distinguishing AHT from non-abusive head trauma (nAHT) is clinically challenging due to overlapping presentations.
- Early AHT recognition is crucial for improving infant outcomes.
Purpose of the Study:
- To compare clinical presentations and outcomes between infants with AHT and nAHT.
- To identify risk factors associated with poor outcomes in infants diagnosed with AHT.
Main Methods:
- Retrospective analysis of TBI patients in a pediatric intensive care unit (2014-2020).
- Comparison of clinical manifestations and outcomes between AHT and nAHT groups.
- Analysis of risk factors for poor outcomes specifically within the AHT cohort.
Main Results:
- AHT patients (18) showed higher rates of conscious change, seizures, limb weakness, and respiratory failure compared to nAHT patients (42).
- Skull fractures were less common in AHT cases.
- AHT was associated with worse outcomes, including increased neurosurgery, higher discharge Pediatric Overall Performance Category scores, and greater anti-epileptic drug use.
Conclusions:
- Abusive head trauma (AHT) is associated with significantly poorer outcomes compared to non-abusive head trauma (nAHT).
- Clinical signs such as conscious change, seizures, and limb weakness are more prevalent in AHT, while skull fractures are less frequent.
- Conscious change serves as both an early warning sign for AHT and an independent risk factor for adverse outcomes, including mortality, ventilator dependence, or need for anti-epileptic drugs.
Background:
Abusive head trauma (AHT) is the leading cause of death in infants with traumatic brain injury (TBI). Early recognition of AHT is important for improving outcomes, but it can be challenging due to its similar presentations with non-abusive head trauma (nAHT). This study aims to compare clinical presentations and outcomes between infants with AHT and nAHT, and to identify the risk factors for poor outcomes of AHT.
Methods:
We retrospectively analyzed infants of TBI in our pediatric intensive care unit from January 2014 to December 2020. Clinical manifestations and outcomes were compared between patients with AHT and nAHT. Risk factors for poor outcomes in AHT patients were also analyzed.
Results:
60 patients were enrolled for this analysis, including 18 of AHT (30%) and 42 of nAHT (70%). Compared with those with nAHT, patients with AHT were more likely to have conscious change, seizures, limb weakness, and respiratory failure, but with a fewer incidence of skull fractures. Additionally, clinical outcomes of AHT patients were worse, with more cases undergoing neurosurgery, higher Pediatric Overall Performance Category score at discharge, and more anti-epileptic drug (AED) use after discharge. For AHT patients, conscious change is an independent risk factor for a composite poor outcome of mortality, ventilator dependence, or AED use (OR = 21.9, P = 0.04) CONCLUSION: AHT has a worse outcome than nAHT. Conscious change, seizures and limb weaknesses but not skull fractures are more common in AHT. Conscious change is both an early reminder of AHT and a risk factor for its poor outcomes.
