Early clinical indicators of developmental outcome in abusive head trauma

Greiner, Mary V.; Lawrence, Alice P.; Horn, Paul S.; Newmeyer, Amy; Makoroff, Kathi L.

doi:10.1007/s00381-012-1714-z

Cited by 21 publications

(8 citation statements)

References 34 publications

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“…20 Associated injuries with neurological impact were significantly more common in children with abusive head trauma; ischemia/infarction and status epilepticus were both 6 times more common in abusive head trauma, and cardiorespiratory arrest/apnea was 4 times more common in abusive head trauma. This is consistent with prior reports of ischemia / infarctions 8, 10, 21 , cardiorespiratory arrest / apnea 2, 22, 23 , and post-traumatic seizures 6, 24 occurring more frequently in abusive head trauma. Similar to prior reports correlating severity of injury with disability in children with TBI, 2, 4, 19 the presence of associated injuries was associated with worse outcome in our sample.…”

Section: Discussionsupporting

confidence: 93%

Functional Outcomes in Children with Abusive Head Trauma Receiving Inpatient Rehabilitation Compared with Children with Nonabusive Head Trauma

Risen¹,

Suskauer²,

DeMatt³

et al. 2014

The Journal of Pediatrics

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Objective To compare clinical features and functional outcomes of age and sex matched children with abusive and non-abusive head trauma receiving inpatient rehabilitation. Study design Children with abusive head trauma (n = 28) and age, sex matched children with non-abusive head trauma (n = 20) admitted to one inpatient pediatric rehabilitation unit from 1995–2012 were studied. Acute hospitalization and inpatient rehabilitation records were retrospectively reviewed for pertinent clinical data: initial GCS score, signs of increased intracranial pressure, neuroimaging findings, and presence of associated injuries. Functional status at admission to and discharge from inpatient rehabilitation was assessed using the Functional Independence Measure for Children (WeeFIM). Outcome at discharge and outpatient follow-up was described based on attainment of independent ambulation and expressive language. Results Children with abusive and non-abusive head trauma had similar levels of injury severity although associated injuries were greater in abusive head trauma. Functional impairment upon admission to inpatient rehabilitation was comparable and functional gains during inpatient rehabilitation were similar between groups. More children with non-abusive than abusive head trauma attained independent ambulation and expressive language after discharge from rehabilitation; the difference was no longer significant when only children greater than 12 months of age at injury were examined. There was variability in delay to obtain these skills and quality of gained skills in both groups. Conclusions Despite more associated injuries, children with abusive head trauma make significant functional gains during inpatient rehabilitation comparable with an age and sex matched sample with non-abusive head trauma. Key functional skills may be gained by children in both groups following discharge from inpatient rehabilitation.

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Section: Discussionsupporting

confidence: 93%

Functional Outcomes in Children with Abusive Head Trauma Receiving Inpatient Rehabilitation Compared with Children with Nonabusive Head Trauma

Risen¹,

Suskauer²,

DeMatt³

et al. 2014

The Journal of Pediatrics

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“…There will always be a need for longitudinal studies evaluating cost, neurological development, disability and recovery, school performance, and psychoso- cial behavior. 9,22 For example, Peterson et al estimated the total medical cost attributable to AHT in the 4 years after diagnosis as $47,952 (95% CI $40,219-$55,685). 21 Interventions targeting known risk factors, such as parenting education for the stress of inconsolable infant crying, have demonstrated good levels of success in fighting pediatric AHT.…”

Section: Discussion Our Resultsmentioning

confidence: 99%

Abusive head trauma: an epidemiological and cost analysis

Boop

Axente

Weatherford

et al. 2016

PED

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OBJECTIVE Research on pediatric abusive head trauma (AHT) has largely focused on clinical presentation and management. The authors sought to review a single-institution experience from a public health perspective to gain a better understanding of the local population affected, determine overall incidence and seasonal trends, and provide details on the initial hospitalization, including extent of injuries, neurosurgical interventions, and hospital charges. METHODS All cases of AHT involving patients who presented to Le Bonheur Children's Hospital (LBCH) from 2009 through 2014 were identified. AHT was defined as skull fracture or intracranial hemorrhage in a child under the age of 5 years with a suspicious mechanism or evidence of other intentional injuries, such as retinal hemorrhages, old or new fractures, or soft-tissue bruising. Injuries were categorized as Grade I (skull fracture only), Grade II (intracranial hemorrhage or edema not requiring surgical intervention), or Grade III (intracranial hemorrhage requiring intervention or death due to brain injury). RESULTS Two hundred thirteen AHT cases were identified. The demographics of the study population are similar to those reported in the literature: the majority of the patients involved were 6 months of age or younger (55%), male (61%), African American (47%), and publicly insured (82%). One hundred one neurosurgical procedures were performed in 58 children, with the most common being bur hole placement for treatment of subdural collections (25%) and decompressive hemicraniectomy (22%). The annual incidence rate rose from 2009 (19.6 cases per 100,000 in the population under 5 years of age) to 2014 (47.4 cases per 100,000) and showed seasonal peaks in January, July, and October (6-year average single-month incidence, respectively, 24.7, 21.7, and 24.7 per 100,000). The total hospital charges were $13,014,584, with a median cost of $27,939. Treatment costs for children who required surgical intervention (i.e., those with Grade III) were up to 10 times those of children with less severe injuries. CONCLUSIONS In the authors' local population, victims of AHT are overwhelmingly infants, are more often male than female, and are disproportionately from lower socioeconomic ranks. The incidence is increasing and initial hospitalization charges are substantial and variable. The authors introduce a simple 3-tiered injury classification scheme that adequately stratifies length of hospital stay and cost.

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“…8–9 Glasgow Coma Scale (GCS) at admission, evidence of hypotension and hypoxia, maintenance of cerebral perfusion pressure and decreasing cerebral metabolism by preventing the development of posttraumatic seizure (PTS) require vigilance and aggressive management for favorable pediatric TBI outcomes. 10–12 …”

Section: Introductionmentioning

confidence: 99%

Continuous electroencephalography in pediatric traumatic brain injury: Seizure characteristics and outcomes

Vaewpanich

Reuter‐Rice

2016

Epilepsy & Behavior

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Background Traumatic injury (TBI) is a major cause of pediatric morbidity and mortality. Secondary injury that occurs as a result of a direct impact plays a crucial role in patient prognosis. The guidelines for the management of severe TBI target treatment of secondary injury. Posttraumatic seizure, one of the secondary injury sequelae, contributes to further damage to the injured brain. Continuous electroencephalography (cEEG) helps detect both clinical and subclinical seizure, which aids early detection and prompt treatment. Objective To examine the relationship between cEEG findings in pediatric traumatic brain injury and neurocognitive/functional outcomes. Methods This study focuses on a subgroup of a larger prospective parent study that examined children admitted to a level-1 trauma hospital. The subgroup included sixteen children admitted to the pediatric intensive care unit (PICU) who received cEEG monitoring. Characteristics included demographics, cEEG reports, antiseizure medication. We also examined outcome scores at time of discharge and 4–6 weeks post-discharge using the Glasgow Outcome Scale-Extended Pediatrics and a center-based speech pathology neurocognitive/functional evaluation scores. Results Sixteen patients were included in this study. Patients with severe TBI made up the majority of those that received cEEG monitoring. Non-accidental trauma was the most frequent TBI etiology (75%) and subdural hematoma was the most common lesion diagnosed by CT scan (75%). Fifteen patients received anti-seizure medication and levetiracetam was the medication of choice. Four patients (25%) developed seizures during PICU admission and 3 patients had subclinical seizures that were detected by cEEG. One of these patients also had both a clinical and subclinical seizure. Non-accidental trauma was an etiology of TBI in all seizure patients. Characteristics of a non-reactive pattern, severe/burst suppression and lack of sleep architecture, on cEEG were associated with poor neurocognitive/functional outcome. Conclusion Continuous electroencephalography demonstrated a pattern that associated seizures and poor outcomes in patients with moderate to severe traumatic brain injury, particularly in a subgroup of non-accidental trauma patients. Best practice should include institutional based TBI cEEG protocols, which may detect early of seizure activity and promote outcomes. Future studies should include examination of individual cEEG characteristics to help improve outcomes in pediatric TBI.

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Early clinical indicators of developmental outcome in abusive head trauma

Cited by 21 publications

References 34 publications

Functional Outcomes in Children with Abusive Head Trauma Receiving Inpatient Rehabilitation Compared with Children with Nonabusive Head Trauma

Functional Outcomes in Children with Abusive Head Trauma Receiving Inpatient Rehabilitation Compared with Children with Nonabusive Head Trauma

Abusive head trauma: an epidemiological and cost analysis

Continuous electroencephalography in pediatric traumatic brain injury: Seizure characteristics and outcomes

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