Inflicted traumatic brain injury (ITBI) or shaken baby syndrome (SBS) in Estonia

Talvik, Inga; Metsvaht, Tuuli; Leito, Kaja; Põder, Haide; Kool, Pille; Väli, Marika; Lintrop, Mare; Kolk, Anneli; Talvik, Tiina

doi:10.1080/08035250500464923

Cited by 54 publications

(52 citation statements)

References 15 publications

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“…These findings are in accordance with previously reported trends. 6,9,14,28 The reporting of secondary diagnoses such as SBS and retinal hemorrhage provides some insight, although limited, on the mechanism of injury and clinical features, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes and factors associated with infant abusive head trauma in the US

Nuño

Pelissier

Varshneya

et al. 2015

PED

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OBJECT Head trauma is the leading cause of death in abused children, particularly prior to the age of 2 years. An awareness of factors associated with this condition as well as with a higher risk of mortality is important to improve outcomes and prevent the occurrence of these events. The objective of this study was to evaluate outcomes and factors associated with poor outcomes in infants with diagnosed abusive head trauma (AHT). Patient characteristics, socioeconomic factors, and secondary conditions such as retinal bleeding, contusion, and fractures were considered. METHODS Data were obtained from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. From the Kids’ Inpatient Database (KID) sample, the authors identified infants no older than 23 months who had been diagnosed with AHT in 2000, 2003, 2006, and 2009. All statistical analyses were conducted in SAS 9.2. Descriptive statistics were provided, and multivariate logistic regression models were applied to evaluate factors associated with mortality and nonroutine discharge. RESULTS A total of 5195 infants were analyzed in this study. Most infants (85.5%) had ages ranging between 0 and 11 months and were male (61.6%). Overall mortality was 10.8%, with a rate of 9.8% in the 0- to 11-month-old cohort and 16.5% in the 12- to 23-month-olds (p = 0.0003). The overall nonroutine discharge rate of 25.6% increased significantly from 23.3% to 39.0% with increasing age (0–11 vs 12–23 months of age, p < 0.0001). Assuming a multivariate model that adjusted for multiple confounders, the authors found that older infants (12–23 vs 0–11 months, OR 1.81, 95% CI 1.18–2.77) with a secondary diagnosis of retinal bleeding (OR 2.85, 95% CI 2.02–4.00) or shaken baby syndrome (OR 2.09, 95% CI 1.48–2.94) had an increased risk of mortality; these factors were similarly associated with an increased odds of a nonroutine discharge. A higher income ($30,001–$35,000 vs $1–$24,999) was associated with a reduction in the odds of mortality (OR 0.46, 95% CI 0.29–0.72). In the subset of cases (1695 [32.6%]) that specified the perpetrator involved in infant injury, the authors found that the father, stepfather, or boyfriend was most frequently reported (67.4%). A trend for a higher AHT incidence was documented in the early ages (peak at 2 months) compared with older ages. CONCLUSIONS Despite the higher incidence of AHT among infants during the earlier months of life, higher mortality was documented in the 12- to 23-month-olds. Retinal bleeding and shaken baby syndrome were secondary diagnoses associated with higher mortality and nonroutine discharge. Males (67.4%) were overwhelmingly documented as the perpetrators involved in the injury of these infants.

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Section: Discussionmentioning

confidence: 99%

“…3,8 Clinical entities associated with AHT include retinal hemorrhages and subdural hematomas. 9,28 Although pertinent information has been obtained from studies published to date, most of these studies have significant limitations, for example, small sample sizes, hospital-specific characteristics, and an inability to generalize findings to infants nationwide.…”

mentioning

confidence: 99%

Outcomes and factors associated with infant abusive head trauma in the US

Nuño

Pelissier

Varshneya

et al. 2015

PED

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“…1 Estimates of the annual incidence of AHT range from 14.7 to 40.5 per 100 000 children under 1 year of age in various studies. [2][3][4][5][6] Male caregivers are more frequently identified as the perpetrators of AHT. [7][8][9][10] However, female perpetrators of AHT may be underestimated, as studies revealed that 2.6% to 5% of mothers report shaking their infants or young children as a means of discipline or in response to crying.…”

mentioning

confidence: 99%

Abusive Head Trauma in Children: A Comparison of Male and Female Perpetrators

2011

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WHAT'S KNOWN ON THIS SUBJECT:Several studies have examined the relationship between perpetrators of abusive head trauma and their victims. However, no study has evaluated the effect of perpetrator gender on victim presentation, victim clinical outcomes, and perpetrator legal outcomes. WHAT THIS STUDY ADDS:This study reports significant gender differences in perpetrators of abusive head trauma in children. Male perpetrators were younger and more likely to confess and be convicted. Victims of male perpetrators had more serious acute presentations and neurosurgical intervention and suffered worse clinical outcomes. abstract OBJECTIVE: To evaluate the effect of perpetrator gender on victim presentation and outcomes, and perpetrator legal outcomes for abusive head trauma (AHT). METHODS:We performed a retrospective chart review of AHT cases from 1998 to 2008. Patient clinical data and information regarding perpetrator legal outcome was obtained. Relationship of brain injury and retinal hemorrhages (RHs) and differences in categorical variables of perpetrator gender were compared by using Fisher's exact test. Differences in continuous variables between perpetrator gender were compared by using the Mann-Whitney Test. RESULTS:There were 34 cases of AHT with identified perpetrators, 17 of each gender. Mean age of the victims was 9.4 months (SD: 7.8). Thirty-two (94%) had intracranial hemorrhages, 14 (41%) had both primary and secondary brain injury, 28 (82%) had RHs, and 6 (18%) died. The severity of RH was related to the severity of brain injuries (P ϭ .01). The median age for female perpetrators (34 years) was higher than that for males (27 years; P ϭ .001). Six categorical variables were associated with male perpetrator gender: acute presenting symptoms of cardiopulmonary or respiratory arrest (P ϭ .025), worse clinical outcome (P ϭ .012), neurosurgical intervention (P ϭ .037), death (P ϭ .018), perpetrator confession (P ϭ .0001), and conviction (P ϭ .005). CONCLUSIONS:There were significant perpetrator gender differences of AHT in children. Male perpetrators were younger and more likely to confess and be convicted. Victims of male perpetrators had more serious acute presentations and neurosurgical intervention and suffered worse clinical outcomes.

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“…However, mixeddensity hematoma is not specific for AHT, because it may be observed within 48 hours of accidental injury (22). Children can present with a low level of consciousness, increased cranial pressure, seizures, apnea, hypotonia, anemia, and/or shock (23). SDH, frequently seen in SBS victims, can also result from accidental trauma, birth trauma, metabolic diseases, tumorous conditions, genetic disorders, and autoimmune disorders (24).…”

Section: Subdural Hemorrhagesmentioning

confidence: 99%

The First Cause of Traumatic Death in Children < 1 Year: A Review on Abusive Head Trauma

et al. 2016

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Context: Pediatric abusive head trauma (AHT) can be defined as an injury to the skull or intracranial contents of a child under the age of 5 due to inflicted blunt impact or violent shaking. Evidence Acquisition: AHT is the most common cause of traumatic death in children younger than 1 year, and it is the leading cause of death due to child abuse. Clinical presentation observed in children with AHT depends on the type of AHT and accompanying injuries. History and physical examination are important for diagnosing AHT and for distinguishing it from other conditions that can mimic shaken baby syndrome, such as accidental trauma, cancer, metabolic diseases, and others. Results: Progress in research on the medical diagnosis of AHT has been remarkable, while the development of treatment strategies has been limited. For these reasons, there is an urgent need to develop effective treatment strategies for AHT able to improve the outcomes. Conclusions:The construction of a nationwide database that supports clinical studies is required in the future.

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Inflicted traumatic brain injury (ITBI) or shaken baby syndrome (SBS) in Estonia

Cited by 54 publications

References 15 publications

Outcomes and factors associated with infant abusive head trauma in the US

Outcomes and factors associated with infant abusive head trauma in the US

Abusive Head Trauma in Children: A Comparison of Male and Female Perpetrators

The First Cause of Traumatic Death in Children < 1 Year: A Review on Abusive Head Trauma

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