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Multiorgan Dysfunction Syndrome in Abusive and Accidental Pediatric Traumatic Brain Injury
Caitlin R McNamara1, Katelyn M Even2, Anne Kalinowski3
1Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. mcnamaracr@upmc.edu.
Insights
Abusive head trauma (AHT) in children leads to more multiorgan dysfunction syndrome (MODS) and worse outcomes than accidental TBI. Both AHT and MODS are linked to lasting impairments after pediatric traumatic brain injury (TBI).
Area of Science:
- Pediatric critical care medicine
- Neurology
- Trauma surgery
Background:
- Abusive head trauma (AHT) is a significant cause of pediatric traumatic brain injury (TBI), associated with high mortality and morbidity.
- Multiorgan dysfunction syndrome (MODS) further increases mortality risk in critically ill children.
- Understanding the interplay between AHT, MODS, and patient outcomes is crucial for effective clinical management.
Purpose of the Study:
- To compare the incidence of MODS in children with AHT versus accidental TBI (aTBI).
- To evaluate the association of MODS and TBI mechanism with new impairments at various time points.
Main Methods:
- A retrospective cohort study of children under 3 years old with nonpenetrating TBI from 2014-2021.
- MODS assessed using the Pediatric Logistic Organ Dysfunction-2 score on days 1, 3, and 7.
- New impairment status evaluated at hospital discharge, and short-term and long-term follow-up using the Functional Status Scale.
Main Results:
- Children with AHT showed significantly higher rates of MODS on days 1, 3, and 7 compared to aTBI.
- Neurologic and respiratory failures were more common in AHT.
- MODS was strongly associated with new impairments at all assessed time points (hospital discharge, short-term, and long-term).
- AHT mechanism was also independently associated with new impairments at all follow-up intervals.
Conclusions:
- Abusive head trauma is a significant mechanism associated with increased MODS following pediatric TBI.
- Both AHT and the presence of MODS are independent predictors of new impairments in children with TBI.
- These findings underscore the severe consequences of AHT and the importance of early recognition and intervention.
Background:
Abusive head trauma (AHT) is a mechanism of pediatric traumatic brain injury (TBI) with high morbidity and mortality. Multiorgan dysfunction syndrome (MODS), defined as organ dysfunction in two or more organ systems, is also associated with morbidity and mortality in critically ill children. Our objective was to compare the frequency of MODS and evaluate its association with outcome between AHT and accidental TBI (aTBI).
Methods:
This was a single center, retrospective cohort study including children under 3 years old admitted to the pediatric intensive care unit with nonpenetrating TBI between 2014 and 2021. Presence or absence of MODS on days 1, 3, and 7 using the Pediatric Logistic Organ Dysfunction-2 score and new impairment status (Functional Status Scale score change > 1 compared with preinjury) at hospital discharge (HD), short-term timepoint, and long-term timepoint were abstracted from the electronic health record. Multiple logistic regression was performed to examine the association between MODS and TBI mechanism with new impairment status.
Results:
Among 576 children, 215 (37%) had AHT and 361 (63%) had aTBI. More children with AHT had MODS on days 1 (34% vs. 23%, p = 0.003), 3 (28% vs. 6%, p < 0.001), and 7 (17% vs. 3%, p < 0.001) compared with those with aTBI. The most common organ failures were cardiovascular ([AHT] 66% vs. [aTBI] 66%, p = 0.997), neurologic (33% vs. 16%, p < 0.001), and respiratory (34% vs. 15%, p < 0.001). MODS was associated with new impairment in multivariable logistic regression at HD (odds ratio 19.1 [95% confidence interval 9.8-38.6, p < 0.001]), short-term discharge (7.4 [3.7-15.2, p < 0.001]), and long-term discharge (4.3 [2.0-9.4, p < 0.001])]. AHT was also associated with new impairment at HD (3.4 [1.6-7.3, p = 0.001]), short-term discharge (2.5 [1.3-4.7, p = 0.005]), and long-term discharge (2.1 [1.1-4.1, p = 0.036]).
Conclusions:
Abusive head trauma as a mechanism was associated with MODS following TBI. Both AHT mechanism and MODS were associated with new impairment at all time points.
