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Mortality after abusive head trauma: Relationship to brain injury severity, age, and co-occurring bodily injuries
Robin L Peterson1, Daniel M Lindberg2, William A Piña-Anastasiadis1
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
Abusive head trauma (AHT) in children is deadly. Lower Glasgow Coma Scale scores and more fractures indicate higher mortality risk in infants and toddlers. Older children face increased risks and different injury patterns.
Area of Science:
- Pediatrics
- Neurology
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a primary cause of death in child physical abuse cases, predominantly affecting young children.
- A lack of standardized brain injury severity measures for infants and toddlers hinders risk identification after AHT.
Purpose of the Study:
- To identify clinical factors associated with mortality in children diagnosed with AHT.
- To investigate age-related differences in injury patterns and mortality risk following AHT.
Main Methods:
- A retrospective chart review of 403 patients treated for AHT between 2012 and 2020 at a tertiary care children's hospital.
- Statistical analyses included t-tests, chi-square tests, and multivariable binary logistic regression to identify predictors of mortality.
Main Results:
- Mortality occurred in 10.4% of cases (42 out of 403).
- Factors significantly linked to mortality included lower Glasgow Coma Scale (GCS) scores, older age, midline shift, eye injuries, fractures, abdominal/visceral injuries, neurosurgical interventions, and intubation.
- Multivariable analysis confirmed that lower GCS and a higher number of fractures were independently associated with increased mortality risk.
Conclusions:
- The Glasgow Coma Scale (GCS) is a valuable tool for assessing infants and toddlers with AHT.
- Older children exhibited a higher mortality rate and distinct injury patterns compared to younger children, suggesting age-specific risk factors.
Background:
Abusive head trauma (AHT), a leading cause of death from child physical abuse, disproportionately impacts the youngest children. Identifying children at highest risk following AHT has been hampered by the lack of a widely accepted measure of brain injury severity in infants and toddlers.
Objective:
Identify clinical factors associated with mortality from AHT.
Participants And Setting:
403 patients (mean age 10.8 months) treated for AHT between 2012 and 2020 at a tertiary care children's hospital.
Methods:
Single-center retrospective chart review. We tested relationships between covariates and mortality with t-tests and chi-square tests; these analyses guided development of a multivariable model using binary logistic regression.
Results:
Forty-two of 403 children died (10.4 %). In bivariate analyses, mortality was linked to lower Glasgow Coma Scale (GCS; d = 2.07, p < .001), older age (d = -0.55, p = .009), midline shift (Φ = 0.10, p = .04), eye injuries (V = 0.42, p < .001), fractures (Φ = 0.14, p = .004), abdominal/visceral injuries (Φ = 0.14, p = .005), neurosurgical interventions (V = 0.22, p < .001), and intubation (Φ = 0.37, p < .001). Older children were at risk for more severe brain injuries and abdominal/visceral injuries. In the multivariable model, lower GCS (p < .001) and more fractures (p = .02) were associated with mortality.
Conclusions:
Our data support the use of GCS in infants and toddlers following AHT. Older children were more likely to die than younger children, with evidence for differing injury patterns by age.
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