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Updated: May 15, 2025
Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Injury, child and family factors predict neurodevelopment outcomes after abusive head trauma
Amy K Connery1, William A Anastasiadis1, Daniel M Lindberg2
1Children's Hospital Colorado, Aurora, CO, United States of America; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States of America.
Insights
A constellation of injury variables, particularly hospital course measures, better predicts neurodevelopmental outcomes in abusive head trauma (AHT) survivors than the Glasgow Coma Scale (GCS) alone. Child and family factors further improved prediction accuracy.
Area of Science:
- Pediatric neurology
- Neurodevelopmental outcomes
- Abusive head trauma research
Background:
- Lack of consensus exists on optimal methods for measuring injury severity in abusive head trauma (AHT).
- Predicting long-term neurodevelopmental outcomes in AHT survivors remains a challenge.
Purpose of the Study:
- To test the hypothesis that a combination of injury-related, child, and family variables more accurately predicts neurodevelopmental outcomes in AHT-affected children than the Glasgow Coma Scale (GCS) alone.
Main Methods:
- 270 AHT survivors (median age 4.6 months) treated between 2012-2020 at a tertiary children's hospital were enrolled.
- Exploratory analyses identified relationships between injury severity, child/family variables, and neurodevelopmental outcomes (Bayley Scales).
- Stepwise multivariate regressions were used to predict outcomes based on selected variables.
Main Results:
- Injury variables, including cytotoxic edema, ICU length of stay, neurosurgery, seizures, intubation, eye, and spine injuries, explained 14-22% more variance in Bayley scores than GCS alone.
- Hospital course measures (ICU stay, neurosurgery, seizures, intubation) demonstrated the largest effect sizes.
- Inclusion of child and family variables added an additional 6-10% to the explained variance in outcomes.
Conclusions:
- A comprehensive set of injury-related variables, especially those reflecting hospital course, is a more potent predictor of neurodevelopmental outcomes in AHT cases than GCS alone.
- Integrating child and family factors further enhances the predictive accuracy for long-term outcomes in AHT survivors.
Background:
There is a lack of consensus on how best to measure injury severity in abusive head trauma in order to predict long-term neurodevelopmental outcomes.
Objective:
We hypothesized that a constellation of injury-related variables along with child and family variables would more accurately predict outcomes in children who have sustained an AHT than the Glasgow Coma Scale (GCS) alone.
Participants And Setting:
In 2012-2020, we enrolled 270 patients (median age 4.6 months) treated for AHT at a large tertiary care children's hospital who survived their injuries and came to a multi-disciplinary follow-up clinic.
Methods:
Exploratory analyses examined bivariate relationships of injury severity and child and family variables with neurodevelopmental outcomes, as measured by the Bayley Scales of Infant and Toddler Development, using Pearson correlations, independent samples t-tests, and one-way ANOVAs. These exploratory analyses informed the selection of variables for stepwise multivariate regressions predicting neurodevelopmental outcomes.
Results:
Stepwise regression revealed that a constellation of injury-related variables including cytotoxic edema, length of intensive care stay, neurosurgical intervention, seizures, intubation, eye injuries, and abnormal spine imaging explained significantly more variance in Bayley scores than GCS alone (14-22 %, all p-values < .01). The largest effect sizes were for measures of hospital course (length of intensive care stay, neurosurgical intervention, seizures, and intubation). Including child and family variables explained an additional 6-10 % of the variance (all p-values < .05).
Conclusions:
A constellation of injury-related variables, especially those related to hospital course, was more predictive of neurodevelopment than solely GCS for children with AHT.
