A Multicenter Study on the Clinical Characteristics and Outcomes Among Children With Moderate to Severe Abusive Head
Adriana Yock-Corrales1, Jan Hau Lee2, Jesús Ángel Domínguez-Rojas3
1Emergency Department.Hospital Nacional de Niños ¨Dr. Carlos Sáenz Herrera. CCSS San José, Costa Rica.
Insights
Abusive Head Trauma (AHT) accounts for 12% of pediatric traumatic brain injuries (TBI). Infants under 2 years and subdural hemorrhages are key indicators for AHT diagnosis in children.
Area of Science:
- Pediatric critical care
- Neurology
- Forensic medicine
Background:
- Abusive Head Trauma (AHT) is a significant cause of pediatric injury.
- Identifying clinical characteristics and risk factors for AHT is crucial for early diagnosis and intervention.
- Understanding outcomes in children with AHT informs clinical management and prognosis.
Purpose of the Study:
- To identify clinical characteristics of children diagnosed with AHT.
- To determine risk factors associated with an AHT diagnosis.
- To describe the outcomes of children with AHT.
Main Methods:
- An observational cohort study was conducted in pediatric intensive care units (PICUs) across 14 countries in Asia and Ibero-America.
- Included were patients under 5 years old with moderate to severe traumatic brain injury (TBI).
- Descriptive analysis and multivariable logistic regression were used to identify risk factors for AHT.
Main Results:
- AHT was diagnosed in 12% of the 392 TBI patients.
- Children with AHT were younger (<2 years), more likely to arrive by private transportation, and less likely to have multiple injuries compared to those with accidental injuries.
- The AHT group had higher rates of subdural hemorrhage (SDH), required more antiepileptic medications and neurosurgical interventions, but had similar mortality and functional outcomes.
Conclusions:
- AHT represents a notable proportion of pediatric TBI cases.
- Younger age (<2 years) and the presence of SDH are independently associated with AHT.
- Children with AHT often require more intensive medical interventions, including neurosurgery and antiepileptic drugs.
Introduction:
We aimed to identify clinical characteristics, risk factors for diagnosis, and describe outcomes among children with AHT.
Methods:
We performed an observational cohort study in tertiary care hospitals from 14 countries across Asia and Ibero-America. We included patients <5 years old who were admitted to participating pediatric intensive care units (PICUs) with moderate to severe traumatic brain injury (TBI). We performed descriptive analysis and multivariable logistic regression for risk factors of AHT.
Results:
47 (12%) out of 392 patients were diagnosed with AHT. Compared to those with accidental injuries, children with AHT were more frequently < 2 years old (42, 89.4% vs 133, 38.6%, p < 0.001), more likely to arrive by private transportation (25, 53.2%, vs 88, 25.7%, p < 0.001), but less likely to have multiple injuries (14, 29.8% vs 158, 45.8%, p = 0.038). The AHT group was more likely to suffer subdural hemorrhage (SDH) (39, 83.0% vs 89, 25.8%, p < 0.001), require antiepileptic medications (41, 87.2% vs 209, 60.6%, p < 0.001), and neurosurgical interventions (27, 57.40% vs 143, 41.40%, p = 0.038). Mortality, PICU length of stay, and functional outcomes at 3 months were similar in both groups. In the multivariable logistic regression, age <2 years old (aOR 8.44, 95%CI 3.07-23.2), presence of seizures (aOR 3.43, 95%CI 1.60-7.36), and presence of SDH (aOR 9.58, 95%CI 4.10-22.39) were independently associated with AHT.
Conclusions:
AHT diagnosis represented 12% of our TBI cohort. Overall, children with AHT required more neurosurgical interventions and the use of anti-epileptic medications. Children younger than 2 years and with SDH were independently associated with a diagnosis of AHT.
Type Of Study:
Observational cohort study.
Level Of Evidence:
III.
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