Clinical Characteristics and Predictors of Poor Hospital Discharge Outcome for Young Children with Abusive Head Trauma

Chen, Chih-Chi; Hsieh, Ping‐Yen; Chen, Carl P.C.; Hsieh, Yu‐Wei; Chung, Chia-Ying; Lin, Kuang-Lin

doi:10.3390/jcm8030390

Cited by 15 publications

(10 citation statements)

References 41 publications

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“…Pediatric TBI covers a wide range of age groups with different mechanisms of injury and mortality rate [ 7 ]. Abusive trauma is particularly common in children less than two years old [ 8 ]. Children younger than four years old had the highest fall-related head injury rate.…”

Section: Introductionmentioning

confidence: 99%

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

Chen

et al. 2021

Brain Sciences

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Traumatic brain injury (TBI) is the leading cause of mortality in children. There are few studies focused on school-aged children with TBI. We conducted this study to identify the early predictors of in-hospital mortality in school-aged children with severe TBI. In this 10 year observational cohort study, a total of 550 children aged 7–18 years with TBI were enrolled. Compared with mild/moderate TBI, children with severe TBI were older; more commonly had injury mechanisms of traffic accidents; and more neuroimage findings of subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), parenchymal hemorrhage, cerebral edema, and less epidural hemorrhage (EDH). The in-hospital mortality rate of children with severe TBI in our study was 23%. Multivariate analysis showed that falls, being struck by objects, motor component of Glasgow coma scale (mGCS), early coagulopathy, and SAH were independent predictors of in-hospital mortality. We concluded that school-aged children with severe TBI had a high mortality rate. Clinical characteristics including injury mechanisms of falls and being struck, a lower initial mGCS, early coagulopathy, and SAH are predictive of in-hospital mortality.

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Section: Introductionmentioning

confidence: 99%

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

Chen

et al. 2021

Brain Sciences

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“…Several studies have reported on neurological outcome after AHT [4,8,29]. This cohort is unique in that we are able to describe long term outcomes in a cohort of consecutive AHT patients identified prospectively and treated with relative uniformity.…”

Section: Frequency Of Individual Gos-e Scoresmentioning

confidence: 99%

“…Despite the high incidence of AHT, study of these patients is largely limited to descriptors of small cohorts identified retrospectively. Age at the time of inflicted injury and presenting Glasgow Coma Score (GCS) are reported as variables predictive of poor outcome at discharge [8]. Acute symptomatic seizures occur in up to 57% of AHT patients [5] and are often non-convulsive [9].…”

Section: Introductionmentioning

confidence: 99%

Abusive Head Trauma in Infants and Children: Identifying Presenting Variables Associated With Outcome

L¹,

Farias‐Moeller²,

H³

et al. 2021

J Pediatr Neurol Neurosci

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Objective: Correlate presenting clinical characteristics of abusive head trauma (AHT) patient with neurological outcome and late seizures. Design:We review 52 cases of presumed abusive head trauma (AHT) in children < 24 months of age admitted to a single center Pediatric Intensive Care Unit (PICU) between 2008 and 2017. Clinical variables were analyzed for association with neurological outcome ≥ 6 months post-injury using the Glasgow outcome score-extended for pediatrics (GOS-E Peds) and late seizures. Only patients with ≥ 4 hours of EEG within the first 72 hours of admission were included. Patients with coma and bilateral fixed and dilated pupils on presentation were excluded.Results: Neurological outcome was assessed in 43 patients, of which 19 (44%) had a poor outcome (GOS-E ≥ 5). Cardiac arrest, GCS ≤ 8 on presentation, parenchymal injury and longer stay in the PICU were identified as risk factors for poor outcome. Late seizures were present in 35% patients and were predicted by parenchymal injury but not acute symptomatic seizures.Conclusions: Cardiac arrest and GCS ≤ 8 were associated with poor outcome after AHT. Late seizures were not predicted by acute symptomatic seizures. Parenchymal injury was associated with both poor neurological outcome and late seizures.

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“…One study in a pediatric ICU disclosed 24% mortality and pre-exiting inflicted injury in 50% of AHT infants [ 88 ]. Another study about the hospital discharge outcome showed that initial Glasgow Coma Scale <5 was a predictor of poor outcome at discharge in children with AHT [ 89 ].…”

Section: Prognosismentioning

confidence: 99%

Pediatric abusive head trauma

Hung

2020

Biomedical Journal

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Abusive head trauma (AHT), used to be named shaken baby syndrome, is an injury to the skull and intracranial components of a baby or child younger than 5 years due to violent shaking and/or abrupt impact. It is a worldwide leading cause of fatal head injuries in children under 2 years. The mechanism of AHT includes shaking as well as impact, crushing or their various combinations through acceleration, deceleration and rotational force. The diagnosis of AHT should be based on the existence of multiple components including subdural hematoma, intracranial pathology, retinal hemorrhages as well as rib and other fractures consistent with the mechanism of trauma. The differential diagnosis must exclude those medical or surgical diseases that can mimic AHT such as traumatic brain injury, cerebral sinovenous thrombosis, and hypoxic-ischemic injury. As for the treatment, most of the care of AHT is supportive. Vital signs should be maintained. Intracranial pressure, if necessary, should be monitored and controlled to ensure adequate cerebral perfusion pressure. There are potential morbidity and mortality associated with AHT, ranging from mild learning disabilities to severe handicaps and death. The prognosis of patients with AHT correlates with the extent of injury identified on CT and MRI imaging. The outcome is associated with the clinical staging, the extent of increased intracranial pressure and the existence of neurological complications such as acquired hydrocephalus or microcephalus, cortical blindness, convulsive disorder, and developmental delay. AHT is a potentially preventable disease, therefore, prevention should be stressed in all encounters within the family, the society and all the healthcare providers.

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Clinical Characteristics and Predictors of Poor Hospital Discharge Outcome for Young Children with Abusive Head Trauma

Cited by 15 publications

References 41 publications

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

Abusive Head Trauma in Infants and Children: Identifying Presenting Variables Associated With Outcome

Pediatric abusive head trauma

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