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Published on: November 19, 2012
New Functional Impairment After Hospital Discharge by Traumatic Brain Injury Mechanism in Younger Than 3 Years Old
Caitlin R McNamara1, Anne Kalinowski1, Christopher M Horvat1
1Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
Insights
Children with abusive head trauma (AHT) face higher risks of new functional impairments and poor outcomes compared to accidental traumatic brain injury (aTBI). These differences persist for up to five years post-discharge, highlighting the severe impact of AHT.
Area of Science:
- Pediatric Traumatology
- Neurology
- Child Abuse Research
Background:
- Traumatic brain injury (TBI) in children carries significant risks of morbidity and mortality.
- Abusive head trauma (AHT) is a specific mechanism of TBI with potentially severe consequences.
- Distinguishing outcomes between AHT and accidental TBI (aTBI) is crucial for understanding long-term effects.
Purpose of the Study:
- To investigate the association between the mechanism of TBI (AHT vs. aTBI) and the frequency of new functional impairment in young children.
- To compare the long-term functional outcomes in children with TBI based on whether the injury was abusive or accidental.
- To determine if AHT is linked to a higher likelihood of poor outcomes, including death and new functional deficits.
Main Methods:
- Retrospective single-center cohort study of children under 3 years old admitted with TBI to a level 1 trauma center.
- Data collected included patient characteristics, TBI mechanism, and Functional Status Scale (FSS) scores at baseline, discharge, and short-term/long-term follow-up.
- Multivariable logistic regression was used to analyze the association between TBI mechanism and new impairment, defined as an FSS increase >1 from baseline.
Main Results:
- Over six years, 460 children with TBI were analyzed (170 AHT, 290 aTBI).
- New functional impairment was significantly more frequent in AHT patients (27-28%) compared to aTBI patients (9-10%) at all follow-up intervals (discharge, short-term, long-term).
- Abusive head trauma mechanism was associated with significantly greater odds of poor outcomes (death and new impairment) at all time points studied.
Conclusions:
- In children under 3 years old with TBI, abusive head trauma is associated with a higher risk of poor outcomes, including new functional impairments, persisting for up to five years post-discharge.
- New impairments in AHT patients affected sensory, communication, and motor domains, with some patients showing continued decline in functional status over time.
- The findings underscore the critical need for early identification and intervention in cases of suspected abusive head trauma to mitigate long-term consequences.
Objectives:
Children who suffer traumatic brain injury (TBI) are at high risk of morbidity and mortality. We hypothesized that in patients with TBI, the abusive head trauma (AHT) mechanism vs. accidental TBI (aTBI) would be associated with higher frequency of new functional impairment between baseline and later follow-up.
Design:
Retrospective single center cohort study.
Setting And Patients:
Children younger than 3 years old admitted with TBI to the PICU at a level 1 trauma center between 2014 and 2019.
Interventions:
None.
Measurements And Main Results:
Patient characteristics, TBI mechanism, and Functional Status Scale (FSS) scores at baseline, hospital discharge, short-term (median, 10 mo [interquartile range 3-12 mo]), and long-term (median, 4 yr [3-6 yr]) postdischarge were abstracted from the electronic health record. New impairment was defined as an increase in FSS greater than 1 from baseline. Patients who died were assigned the highest score (30). Multivariable logistic regression was performed to determine the association between TBI mechanism with new impairment. Over 6 years, there were 460 TBI children (170 AHT, 290 aTBI), of which 13 with AHT and four with aTBI died. Frequency of new impairment by follow-up interval, in AHT vs. aTBI patients, were as follows: hospital discharge (42/157 [27%] vs. 27/286 [9%]; p < 0.001), short-term (42/153 [27%] vs. 26/259 [10%]; p < 0.001), and long-term (32/114 [28%] vs. 18/178 [10%]; p < 0.001). Sensory, communication, and motor domains were worse in AHT patients at the short- and long-term timepoint. On multivariable analysis, AHT mechanism was associated with greater odds (odds ratio [95% CI]) of poor outcome (death and new impairment) at hospital discharge (4.4 [2.2-8.9]), short-term (2.7 [1.5-4.9]), and long-term timepoints (2.4 [1.2-4.8]; p < 0.05).
Conclusions:
In patients younger than 3 years old admitted to the PICU after TBI, the AHT mechanism-vs. aTBI-is associated with greater odds of poor outcome in the follow-up period through to ~5 years postdischarge. New impairment occurred in multiple domains and only AHT patients further declined in FSS over time.
