Severe Pediatric Traumatic Brain Injury Presenting Characteristics: Abusive Versus Accidental Trauma

Area of Science:

• Pediatric Traumatology
• Neurocritical Care
• Forensic Medicine

Background:

• Abusive head trauma (AHT) is a significant cause of mortality and severe morbidity in infants and young children.
• Distinguishing AHT from accidental traumatic brain injury (aTBI) is critical for appropriate medical management and legal/social interventions.
• Previous studies have identified differences, but age-stratified comparisons are essential due to developmental variations in young children.

Purpose of the Study:

• To perform an age-stratified comparison of clinical and radiological findings between AHT and aTBI in children under 5 years old.
• To identify unique characteristics of AHT that differentiate it from aTBI across different pediatric age groups (<1, 1-2.9, and 3-4.9 years).
• To analyze data from the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury (ADAPT) study.

Main Methods:

• Retrospective analysis of severe traumatic brain injury (TBI) cases from the ADAPT database (February 2014 - September 2017).
• Inclusion criteria: subjects <5 years old admitted to a US study site with an intracranial pressure monitor.
• Stratification by mechanism of injury (AHT vs. aTBI) and age groups. Comparison of epidemiological data, clinical events, and imaging findings prior to monitor placement.

Main Results:

• AHT cases showed higher frequencies of apnea, seizures, and bilateral fixed pupils compared to aTBI.
• Radiological findings more common in AHT included subdural hemorrhages, midline shift, and ischemia; contusion, subarachnoid hemorrhage, and diffuse axonal injury were less frequent.
• In infants <1 year, apnea and seizures did not differ, but ischemia was more prevalent in AHT.

Conclusions:

• Abusive head trauma exhibits distinct clinical and radiological signatures compared to accidental TBI, even when stratified by age.
• Specific findings like subdural hemorrhages and ischemia are key indicators, though some symptoms like apnea and seizures may not differ in the youngest infants.
• Further research is warranted to optimize therapies for this vulnerable pediatric population.