A Multicenter Study on the Clinical Characteristics and Outcomes Among Children With Moderate to Severe Abusive Head Trauma

• Published in: Journal of pediatric surgery Vol. 59; no. 3; pp. 494 - 499
• Main Authors: Yock-Corrales, Adriana, Lee, Jan Hau, Domínguez-Rojas, Jesús Ángel, Caporal, Paula, Roa, Juan D., Fernandez-Sarmiento, Jaime, González-Dambrauskas, Sebastián, Zhu, Yanan, Abbas, Qalab, Kazzaz, Yasser, Dewi, Dianna Sri, Chong, Shu-Ling, Liu, Jun, Chor, Yek Kee, Gan, Chin Seng, Ong, Jacqueline, Anantasit, Nattachai, Samransamruajkit, Rujipat, Kurosawa, Hiroshi, Ming, Mei Xiu, Dang, Hongxing, Lee, Pei-Chuen, Liu, Chunfeng, Kazzaz, Yasser M., Roa G, Juan D., Fernández-Sarmiento, Jaime, Gómez Arriola, Natalia Elizabeth, Ardila Gómez, Ivan Jose, Jaramillo Bustamante, Juan Camilo, Aparicio, Gabriela, Pantoja Chamorro, Freddy Israel, Terán Miranda, Thelma Elvira, Flores, Marisol Fonseca, Torre Gómez, Rosa Elena de la, Pilar Orive, Francisco Javier, Lasso Palomino, Rubén Eduardo, Watzlawik, Natalia Zita, Guier-Bonilla, Luisana, Turina, Deborah M., Rodríguez, María Miñambres, Domínguez Rojas, Jesús Ángel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: Abusive head trauma; Child; Infant; Neurocritical care; CT; PCPC; SDH; GCS; Abusive head trauma; Infant; TBI; Neurocritical care; Child; AHT; PICU
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.09.038

We aimed to identify clinical characteristics, risk factors for diagnosis, and describe outcomes among children with AHT. We performed an observational cohort study in tertiary care hospitals from 14 countries across Asia and Ibero-America. We included patients <5 years old who were admitted to participating pediatric intensive care units (PICUs) with moderate to severe traumatic brain injury (TBI). We performed descriptive analysis and multivariable logistic regression for risk factors of AHT. 47 (12%) out of 392 patients were diagnosed with AHT. Compared to those with accidental injuries, children with AHT were more frequently < 2 years old (42, 89.4% vs 133, 38.6%, p < 0.001), more likely to arrive by private transportation (25, 53.2%, vs 88, 25.7%, p < 0.001), but less likely to have multiple injuries (14, 29.8% vs 158, 45.8%, p = 0.038). The AHT group was more likely to suffer subdural hemorrhage (SDH) (39, 83.0% vs 89, 25.8%, p < 0.001), require antiepileptic medications (41, 87.2% vs 209, 60.6%, p < 0.001), and neurosurgical interventions (27, 57.40% vs 143, 41.40%, p = 0.038). Mortality, PICU length of stay, and functional outcomes at 3 months were similar in both groups. In the multivariable logistic regression, age <2 years old (aOR 8.44, 95%CI 3.07-23.2), presence of seizures (aOR 3.43, 95%CI 1.60-7.36), and presence of SDH (aOR 9.58, 95%CI 4.10-22.39) were independently associated with AHT. AHT diagnosis represented 12% of our TBI cohort. Overall, children with AHT required more neurosurgical interventions and the use of anti-epileptic medications. Children younger than 2 years and with SDH were independently associated with a diagnosis of AHT. Observational cohort study. III.