Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma

Abstract

Over half of fatal pediatric traumatic brain injuries are estimated to be the result of physical abuse, i.e., abusive head trauma (AHT). Although intimate partner violence (IPV) is a well-established risk for child maltreatment, little is known about IPV as an associated risk factor specifically for AHT. We performed a single-institution, retrospective review of all patients (0–17 years) diagnosed at a Level 1 pediatric trauma center with head trauma who had been referred to an in-hospital child protection team for suspicion of AHT between 2010 and 2016. Data on patient demographics, hospitalization, injury, family characteristics, sociobehavioral characteristics, physical examination, laboratory findings, imaging, discharge, and forensic determination of AHT were extracted from the institution’s forensic registry. Descriptive statistics (mean, median), chi-square and Mann–Whitney U tests were used to compare patients with fatal head injuries to patients with nonfatal head injuries by clinical characteristics, family characteristics, and forensic determination. Multiple logistic regression was used to estimate adjusted odds ratios for the presence of IPV as an associated risk of AHT while controlling for other clinical and family factors. Of 804 patients with suspicion for AHT in the forensic registry, there were 240 patients with a forensic determination of AHT; 42 injuries were fatal. There were 101 families with a reported history of IPV; 64.4% of patients in families with reported IPV were <12 months of age. IPV was associated with a twofold increase in the risk of AHT (Exp( β) = 2.3 [ p = .02]). This study confirmed IPV was an associated risk factor for AHT in a single institution cohort of pediatric patients with both fatal and nonfatal injuries. Identifying IPV along with other family factors may improve detection and surveillance of AHT in medical settings and help reduce injury, disability, and death.

Abusive Head Trauma in Infants During the COVID-19 Pandemic in the Paris Metropolitan Area

“…4,5 AHT is the most frequent cause of traumatic death in infants in high-income countries, 1,2 and nonlethal forms are associated with severe long-term morbidity, such as neurodevelopmental impairment (microcephaly, epilepsy, motor and visual deficiencies, language disorders, intellectual disability, and behavioral abnormalities) leading to severe lifelong disabilities. 6 Among the known risk factors of AHT, several could have seen their prevalence modified by the COVID-19 pandemic and the containment and mitigation measures taken to reduce the spread of the disease 7,8 : psychosocial distress (economic loss and unemployment, frustration intolerance, adult psychiatric disorders, and intimate partner violence), 9,10 lifestyle changes (remote work from home in small collective housing, school and childcare facility closures, complete national lockdowns, and curfews), 11 and disorganized social services. 9,12 Concerns were raised early regarding a potentially marked increase in CAN (notably AHT) in association with the COVID-19 pandemic and related containment and mitigation measures.…”

Age-at-Injury Determines the Extent of Long-Term Neuropathology and Microgliosis After a Diffuse Brain Injury in Male Rats

“…Worldwide, the rate of TBI is high, wherein a recent metaanalysis indicated the highest incidence to be in Australasia, at an estimated 415 in every 100,000 people (6). Across the lifespan, TBI is most prevalent in early-life due to domestic violence/child abuse and falls (7)(8)(9)(10), with secondary peaks in adolescence and aged individuals attributed to increased risktaking behaviors (i.e., driving) and falls, respectively (7). Due to the high prevalence of 18-to 25-year-old male individuals that sustain a TBI (7), clinical and experimental research has focused on the behavioral and neuropathological outcomes in young adult males.…”

Age-At-Injury Influences the Glial Response to Traumatic Brain Injury in the Cortex of Male Juvenile Rats

“…Such prolonged microglial activation is often associated with negative developmental outcomes, such as chronic behavioral deficits, progressive cortical thickness reduction, decreased corpus callosum area, neurodegeneration, and cognitive deficits ( 24 , 66 – 69 ). In the clinic, behavioral and affective outcomes are exacerbated in patients injured at a younger age; therefore, our study introduces a plausible, microglia-centric reason for this ( 3 , 66 , 70 ).…”

“…Toddlers (0–4 years) and adolescents (15–18 years) are vulnerable subgroups of the population in which the incidence of traumatic brain injury (TBI) peaks ( 1 ). Higher prevalence of TBIs in these age groups is primarily associated with participation in sports ( 2 ), car accidents, domestic violence ( 3 , 4 ), and falls ( 5 ). Understanding the cellular response to injury in an age-specific manner is important to enable effective patient care and personalized medicine.…”