scholarly journals Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team

2015 ◽  
Vol 100 (12) ◽  
pp. 1123-1130 ◽  
Author(s):  
Patrick Kelly ◽  
Simon John ◽  
Andrea L Vincent ◽  
Peter Reed
Keyword(s):  
Head Injury ◽  
Head Trauma ◽  
Child Protection ◽  
Economic Status ◽  
Head Injuries ◽  
Abusive Head Trauma ◽  
Ischaemic Injury ◽  
Risk Of Death ◽  
Socio Economic Status ◽  
Comparative Review

AimTo describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand.MethodsComparative review of demographics, histories, injuries, investigations and diagnostic outcomes for referrals under 15 years old from 1991 to 2010.ResultsRecords were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%).ConclusionsThe striking increase in referrals for AHT probably represents increasing incidence. The decision to refer a hospitalised child with a head injury for assessment for possible AHT should not be influenced by socio-economic status or ethnicity. Children over 2 years old hospitalised for AHT are usually injured by mechanisms involving impact and should be considered at high risk of death.

Nonaccidental Trauma

2018 ◽  
Author(s):  
Alyssa Padover ◽  
Jennifer K. Lee
Keyword(s):  
Child Abuse ◽  
Head Trauma ◽  
Complex Disease ◽  
Treatment Guidelines ◽  
Pediatric Trauma ◽  
Abusive Head Trauma ◽  
Multiple Organ ◽  
Risk Of Death ◽  
Nonaccidental Trauma ◽  
Organ Systems

Nonaccidental trauma from child abuse presents unique challenges to the anesthesiologist. Diagnosing abuse is difficult because children may present with nonspecific symptoms and vague clinical histories. Multiple organ systems may be involved, but the greatest risk of death stems from abusive head trauma. Anesthesiologists must know the pediatric traumatic brain injury treatment guidelines and be prepared to treat the complex disease processes of child abuse and abusive head trauma. This chapter discusses anesthesia for nonaccidental pediatric trauma, including abusive head trauma. Topics covered include cervical instability, intracranial hypertension, seizures, and anesthetic agents. Debriefing after a poor outcome is also covered.

scholarly journals Validation of the PredAHT-2 prediction tool for abusive head trauma

2020 ◽  
Vol 37 (3) ◽  
pp. 119-126 ◽  
Author(s):  
Helena Pfeiffer ◽  
Laura Elizabeth Cowley ◽  
Alison Mary Kemp ◽  
Stuart R Dalziel ◽  
Anne Smith ◽  
...  
Keyword(s):  
New Zealand ◽  
Head Trauma ◽  
Predictive Value ◽  
Head Injuries ◽  
Secondary Analysis ◽  
Area Under The Curve ◽  
Abusive Head Trauma ◽  
Long Bone ◽  
Prediction Tool ◽  
Zealand Population

ObjectiveThe validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool calculates the probability of abusive head trauma (AHT) in children <3 years of age who have sustained intracranial injuries (ICIs) identified on neuroimaging, based on combinations of six clinical features: head/neck bruising, seizures, apnoea, rib fracture, long bone fracture and retinal haemorrhages. PredAHT version 2 enables a probability calculation when information regarding any of the six features is absent. We aimed to externally validate PredAHT-2 in an Australian/New Zealand population.MethodsThis is a secondary analysis of a prospective multicentre study of paediatric head injuries conducted between April 2011 and November 2014. We extracted data on patients with possible AHT at five tertiary paediatric centres and included all children <3 years of age admitted to hospital who had sustained ICI identified on neuroimaging. We assigned cases as positive for AHT, negative for AHT or having indeterminate outcome following multidisciplinary review. The estimated probability of AHT for each case was calculated using PredAHT-2, blinded to outcome. Tool performance measures were calculated, with 95% CIs.ResultsOf 87 ICI cases, 27 (31%) were positive for AHT; 45 (52%) were negative for AHT and 15 (17%) had indeterminate outcome. Using a probability cut-off of 50%, excluding indeterminate cases, PredAHT-2 had a sensitivity of 74% (95% CI 54% t o89%) and a specificity of 87% (95% CI 73% to 95%) for AHT. Positive predictive value was 77% (95% CI 56% to 91%), negative predictive value was 85% (95% CI 71% to 94%) and the area under the curve was 0.80 (95% CI 0.68 to 0.92).ConclusionPredAHT-2 demonstrated reasonably high point sensitivity and specificity when externally validated in an Australian/New Zealand population. Performance was similar to that in the original validation study.Trial registration numberACTRN12614000463673.

CHARACTERISTICS OF MODERATE AND SEVERE HEAD INJURIES AT EMERGENCY DEPARTMENT HUE CENTRAL HOSPITAL

2017 ◽  
pp. 122-126
Author(s):  
Trong Ai Quoc Hoang ◽  
That Hoang Quy Ton ◽  
Dang Tri Vo ◽  
Thi Kim Tram Hoang ◽  
Thi Thanh Nga Chau
Keyword(s):  
Risk Factors ◽  
Head Injury ◽  
Head Trauma ◽  
Traffic Accident ◽  
Head Injuries ◽  
Ct Scanner ◽  
Central Hospital ◽  
Term Outcome ◽  
Cross Sectional ◽  
Glasgow Score

Background: Head injury is one of common trauma at ED. It is also main cause of dead and disability of trauma. In Vietnam, accident traffic is most common cause of head injury. ED admits a large number of moderate and severe head injury patients everyday. These injuries can result in physical and mental consequences because of traumatic brain injury (TBI); burden to family and society. However, there is not a consensus in statistics of cause, severe symptom, risk factors to severity and short-term outcome at these patients. Objectives: assessement of cause, symptom and risk factors of moderate and severe head injuries as well as presentations of CT scanner. Materials and Methods: This is a cross sectional study. Population of interest: Patients with trauma who transported to ED of Hue Central Hospital and classified as moderate and severe head injuries were chosen conveniently into the study. Inclusion criteria: Patients with trauma by any reason; Glasgow score≤13, Sample size: There was not limitation of case number. Results: There were 50 patients with severe and moderate head injury. Main cause of trauma was traffic accident (92.2%). Patients were transported to ED by private vehicles (84,3%). Mean age of male was 38.20±14.28, female was 33.00±17.82 (p>0.05). Most of accident were not witnessed by family and not rescued by bystanders. There was an evaluable concentration of plasma ethanol in 88.2% of patients with mean level of 33.99±21.88 mmol/L in male and 12.90±19.98 mmol/L in female (p<0.05). Ethanol levels in severe head trauma were lower than ones in moderate head trauma (p<0.001). Ethanol levels were not different in patients with different lesions on CT scanners (p>0.05). It existed a correlation between Glasgow score and ethanol levels (r=0.43, p<0.01). Expired rate of patient at ED was 21.6%. Conclusion: Main cause of trauma was traffic accident (99.2%). There were 88.2% of patients used ethanol before trauma; 15.7% of patients were transported by ambulance. There were 64.7% with headache; amnesia of accident 82.4%; vomiting 78.4%; scalp wound 45.1%; ear bleeding 7.8%; nose bleeding 7.8%; raccoon eye 19.6%. It did not exist a difference of ethanol levels in different lesions on head CT scanner. Expired rate of patient at ED was 21.6%. Key words: head injury, traffic accident, ethanol, Glasgow

Why I Have Difficulty Being Enthusiastic About Recommending That Children Wear Helmets on Bicycles

PEDIATRICS ◽  
1987 ◽  
Vol 79 (3) ◽  
pp. 488-488
Author(s):  
BARRY D. WEISS
Keyword(s):  
At Risk ◽  
Head Injury ◽  
Head Trauma ◽  
Motor Vehicle ◽  
Head Injuries ◽  
Preventive Health ◽  
Childhood Mortality

In Reply.— Dr Ciastko raises an important point. Serious head injury is not limited to victims of bicycle mishaps. Pedestnians, motor vehicle occupants, playground users, and others are all at risk for serious head injury. Physicians and others involved in preventive health cane certainly should direct their efforts at preventing these other causes of childhood mortality and death. Nonetheless, the importance of bicycle-related head trauma should not be underestimated. Despite Dr. Ciastko's findings, the literature suggests that bicycle mishaps are an important cause of serious head injuries.

Demographics of abusive head trauma in the Commonwealth of Pennsylvania

2008 ◽  
Vol 1 (5) ◽  
pp. 351-356 ◽  
Author(s):  
Henry Kesler ◽  
Mark S. Dias ◽  
Michele Shaffer ◽  
Carroll Rottmund ◽  
Kelly Cappos ◽  
...  
Keyword(s):  
Head Trauma ◽  
Head Injuries ◽  
Abusive Head Trauma ◽  
Population Based ◽  
Birth Certificates ◽  
Study Cohort ◽  
Demographic Information ◽  
Low Birth Weight Infants ◽  
Population Based Study ◽  
Demographic Features

Object The aim of this study was to characterize the prevalence and demographic features of abusive head trauma (AHT) among infants and children < 36 months of age in Pennsylvania. Methods The authors included all cases of substantiated AHT involving children < 36 months of age in Pennsylvania between 1996 and 2002 that had been reported to a statewide registry. Demographic information was derived from child abuse reports and birth certificates; the study cohort was contrasted with all infants born in Pennsylvania during the same period. Results The study identified 327 cases. The incidence was 14.7 cases (95% confidence interval 13.1–16.5) per 100,000 person-years for the first 2 years of life with a higher incidence during the 1st year (26.0 cases per 100,000 person-years) than the 2nd year (3.4 cases per 100,000 person-years). The incidence was similar among metropolitan, non-metropolitan, and rural counties. Significantly more cases occurred during the holiday months (October–December). The median age of victims was 4.1 months. Both victims and perpetrators were more commonly male (58.4% of victims, and 70% of identified perpetrators). Compared with the entire population of Pennsylvania parents, the parents of the study cohort were more likely to be younger, less educated, and unmarried. Both mothers and fathers were more often African-American and fathers more often Hispanic. Finally, mothers more often smoked during pregnancy, sought prenatal care later in the pregnancy, and delivered low birth weight infants. Conclusions This population-based study of abusive head injuries throughout an entire state adds significantly to the growing knowledge about this condition. The results suggests that families of infants with abusive head injuries have significantly different demographic features compared with the general population, although which of these variables is independently significant cannot be ascertained from this study and require further investigation.

scholarly journals Acceptability of the Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A qualitative study with child protection professionals

2018 ◽  
Vol 81 ◽  
pp. 192-205 ◽  
Author(s):  
Laura E. Cowley ◽  
Sabine Maguire ◽  
Daniel M. Farewell ◽  
Harriet D. Quinn-Scoggins ◽  
Matthew O. Flynn ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Head Trauma ◽  
Child Protection ◽  
Abusive Head Trauma ◽  
Prediction Tool ◽  
Clinical Prediction ◽  
Clinical Prediction Tool

Trends in admission and death rates due to paediatric head injury in England, 2000–2011

2015 ◽  
Vol 100 (12) ◽  
pp. 1136-1140 ◽  
Author(s):  
Robin Marlow ◽  
Julie Mytton ◽  
Ian K Maconochie ◽  
Hazel Taylor ◽  
Mark D Lyttle
Keyword(s):  
Head Injury ◽  
Traffic Accidents ◽  
Hospital Admissions ◽  
Road Traffic ◽  
Head Injuries ◽  
National Guidelines ◽  
Number Of Children ◽  
Risk Of Death ◽  
Paediatric Head Injury ◽  
The Uk

BackgroundThe number of children admitted to hospital is increasing year on year, with very short-stay admissions doubling in the last decade. Childhood head injury accounts for half a million emergency department attendances in the UK every year. The National Institute for Health and Care Excellence (NICE) has issued three iterations of evidence-based national guidance for head injury since 2003.ObjectivesTo assess if any changes in the rates of admission, death or causes of head injury could be temporally associated with the introduction of sequential national guidelines by longitudinal analysis of the epidemiology of paediatric head injury admissions in England from 2000 to 2011.MethodsRetrospective analysis of English Hospital Episode Statistics data of children under the age of 16 years old admitted to hospital with the discharge diagnosis of head injury.ResultsThe number of hospital admissions with paediatric head injury in England rose by 10% from 34 150 in 2000 to 37 430 in 2011, with the proportion admitted for less than 1 day rising from 38% to 57%. The main cause of head injury was falls (42–47%). Deaths due to head injury decreased by 52% from 76 in 2000 to 40 in 2011. Road traffic accidents were the main cause of death in the year 2000 (67%) but fell to 40% by 2011. In 2000, children who were admitted or died from head injuries were more than twice as likely to come from the most deprived homes compared with least deprived homes. By 2011, the disparity for risk of admission had narrowed, but no change was seen for risk of death.ConclusionsTemporal relationships exist between implementation of NICE head injury guidance and increased admissions, shorter hospital stay and reduced mortality. The underlying cause of this association is likely to be multifactorial.

Pediatric Abusive Head Trauma Prevention Initiatives: A Literature Review

2016 ◽  
Vol 19 (5) ◽  
pp. 555-566 ◽  
Author(s):  
Nahara Rodrigues Laterza Lopes ◽  
Lúcia Cavalcanti de Albuquerque Williams
Keyword(s):  
Head Injury ◽  
Literature Review ◽  
Key Words ◽  
Head Trauma ◽  
Emotional Regulation ◽  
Parental Education ◽  
Shaken Baby Syndrome ◽  
Abusive Head Trauma ◽  
Prevention Strategies ◽  
Infant Crying

Abusive head trauma (AHT) is a serious form of child maltreatment that needs to be prevented. The aim of this study was to summarize the main AHT prevention strategies described in literature, aiming to identify evidence of their efficiency, as well as strengths and limitations. International databases were reviewed from 2005 to 2015 using the key words Shaken Baby Syndrome or abusive head trauma or nonaccidental head trauma or abusive head injury or nonaccidental head injury and prevention. A total of 1,215 articles were found and 34 complete articles were selected for this study. Five initiatives with the main objective of reducing infant crying in the first months of life were found, three aimed at caregiver’s emotional regulation and 12 aimed at raising parents and caregivers awareness on AHT. Among them, parental education about infant crying and risks of shaking a baby stands out for its empirical evidence.

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