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

Abstract

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.

Abusive head trauma: an epidemiological and cost analysis

“…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.…”

Longitudinal Developmental Outcomes after Traumatic Brain Injury in Young Children: Are Infants More Vulnerable Than Toddlers?

“…Rehabilitative services improve outcomes of young children with abusive and non-abusive severe TBI. 41 Physicians may not consider ECI for TBI, although it is routine for infants with congenital disorders and pre-maturity. Additionally, funding challenges for ECI have limited its availability for some children, resulting in substantial unmet service needs.…”

Ongoing Pediatric Health Care for the Child Who Has Been Maltreated

“…72,[74][75][76] Children with AHT are slower to recover from their brain injury than children with similar injuries that are not the result of abuse. 77 Children who suffered from AHT are at risk for microcephaly (from cerebral atrophy) or macrocephaly (from hydrocephalus). 78 Cerebral injury can result in a number of consequences.…”