Abusive head trauma in infants: An observational single centre study comparing developmental and functional outcome
Charles Dekun Lai1, Mary J Marret2, Subhashini Jayanath2
1Department of Paediatrics, University of Malaya, 50603 Kuala Lumpur, Malaysia; Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak.
Insights
Abusive head trauma (AHT) survivors often show developmental delays, even with good functional scores. Comprehensive assessment using tools like the Schedule of Growing Skills II (SGS II) is crucial for identifying deficits in young children post-AHT.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Child abuse research
Background:
- Abusive head trauma (AHT) is a leading cause of infant traumatic brain injury.
- Early identification of developmental deficits in AHT survivors is critical.
Purpose of the Study:
- To compare standardized developmental assessment with functional outcome assessment in young AHT survivors.
- To evaluate the effectiveness of different assessment tools in detecting deficits.
Main Methods:
- An observational, cross-sectional study of 17 AHT survivors aged 18 months to 5 years.
- Utilized the Schedule of Growing Skills II (SGS II) for developmental assessment and the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds) for functional outcomes.
- Extracted clinical data from medical records.
Main Results:
- Most survivors (14/17) exhibited delays in at least one developmental domain, irrespective of neuroimaging findings.
- Hearing and language domains were most frequently affected.
- A positive correlation was found between favorable GOS-E Peds scores and the number of delayed developmental domains (r=0.805, p<0.05).
Conclusions:
- The SGS-II detects behavioral and cognitive deficits missed by the GOS-E Peds.
- Combining SGS II and GOS-E Peds offers a comprehensive assessment profile for AHT survivors.
- Early detection of developmental issues highlights the public health importance of AHT prevention.
Background:
Abusive head trauma (AHT) is a major cause of traumatic brain injury in infancy. This exploratory study compared standardized developmental assessment versus functional outcome assessment between 18 months and 5 years of age following AHT in infancy.
Methods:
Observational cross-sectional study after surviving AHT in infancy. Seventeen children between 18 months and 5 years of age underwent clinical examination, developmental assessment using the Schedule of Growing Skills II (SGS II) and functional assessment using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds). Additional clinical information was extracted from medical records.
Results:
Age at assessment ranged from 19 to 53 months (median 26 months). Most (n = 14) were delayed in at least 1 domain, even without neurological or visual impairment or visible cortical injury on neuroimaging, including 8 children with favourable GOS-E Peds scores. The most affected domain was hearing and language. Delay in the manipulative domain (n = 6) was associated with visual and/or neurological impairment and greater severity of delay across multiple domains. Eleven (64.7 %) had GOS-E Peds scores indicating good recovery, with positive correlation between GOS-Peds scores and number of domains delayed (r = 0.805, p < 0.05).
Conclusion:
The SGS-II detects behavioural and cognitive deficits not picked up by the GOS-E Peds. Combining both tools for assessment of AHT survivors under 5 years of age provides a comprehensive profile which addresses multiple domains of development and function, facilitating targeted intervention. Detection of developmental problems in the majority of survivors makes AHT prevention a public health priority.
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