scholarly journals Clinical Characteristics and Predictors of Poor Hospital Discharge Outcome for Young Children with Abusive Head Trauma

2019 ◽  
Vol 8 (3) ◽  
pp. 390 ◽  
Author(s):  
Chih-Chi Chen ◽  
Po-Chuan Hsieh ◽  
Carl Chen ◽  
Yu-Wei Hsieh ◽  
Chia-Ying Chung ◽  
...  
Keyword(s):  
Head Trauma ◽  
Head Injuries ◽  
Abusive Head Trauma ◽  
Older Age ◽  
Subdural Hemorrhage ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Radiologic Findings ◽  
Early Predictors ◽  
Poor Outcomes

Children with abusive head trauma tend to have worse outcomes than children with accidental head trauma. However, current predictors of poor outcomes for children with abusive head trauma are still limited. We aim to use clinical data to identify early predictors of poor outcome at discharge in children with abusive head trauma. In the 10-year observational retrospective cohort study, children aged between zero and four years with abusive or accidental head trauma were recruited. Multivariate logistic regression models were applied to evaluate factors associated with poor prognosis in children with abusive head trauma. The primary outcome was mortality or a Glasgow Coma Scale (GCS) motor component score of less than 6 at discharge. A total of 292 head trauma children were included. Among them, 59 children had abusive head trauma. In comparison to children with accidental head trauma, children with abusive head trauma were younger, had more severe head injuries, and experienced a higher frequency of post-traumatic seizures. Their radiologic findings showed common presence of subdural hemorrhage, cerebral edema, and less epidural hemorrhage. They were more in need of neurosurgical intervention. In the multivariate analysis for predictors of poor outcome in children with abusive head trauma, initial GCS ≤ 5 (versus GCS > 5 with the adjusted odds ratio (OR) = 25.7, 95% confidence interval (CI) = 1.5–432.8, p = 0.024) and older age (per year with the adjusted OR = 3.3, 95% CI = 1.2–9.5, p = 0.024) were independently associated with poor outcome. These findings demonstrate the characteristic clinical differences between children with abusive and accidental head trauma. Initial GCS ≤ 5 and older age are predictive of poor outcome at discharge in children with abusive head trauma.

scholarly journals Initial clinical presentation of children with acute and chronic versus acute subdural hemorrhage resulting from abusive head trauma

2015 ◽  
Vol 16 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Kenneth W. Feldman ◽  
Naomi F. Sugar ◽  
Samuel R. Browd
Keyword(s):  
Head Trauma ◽  
Clinical Presentation ◽  
Abusive Head Trauma ◽  
Group Differences ◽  
Similar Proportion ◽  
Subdural Hemorrhage ◽  
Retinal Hemorrhages ◽  
Clinical Presentations ◽  
Scale Scores ◽  
Multicenter Retrospective Review

OBJECT At presentation, children who have experienced abusive head trauma (AHT) often have subdural hemorrhage (SDH) that is acute, chronic, or both. Controversy exists whether the acute SDH associated with chronic SDH results from trauma or from spontaneous rebleeding. The authors compared the clinical presentations of children with AHT and acute SDH with those having acute and chronic SDH (acute/chronic SDH). METHODS The study was a multicenter retrospective review of children who had experienced AHT during 2004–2009. The authors compared the clinical and radiological characteristics of children with acute SDH to those of children with acute/chronic SDH. RESULTS The study included 383 children with AHT and either acute SDH (n = 291) or acute/chronic SDH (n = 92). The children with acute/chronic SDH were younger, had higher initial Glasgow Coma Scale scores, fewer deaths, fewer skull fractures, less parenchymal brain injury, and fewer acute noncranial fractures than did children with acute SDH. No between-group differences were found for the proportion with retinal hemorrhages, healing noncranial fractures, or acute abusive bruises. A similar proportion (approximately 80%) of children with acute/chronic SDH and with acute SDH had retinal hemorrhages or acute or healing extracranial injures. Of children with acute/chronic SDH, 20% were neurologically asymptomatic at presentation; almost half of these children were seen for macrocephaly, and for all of them, the acute SDH was completely within the area of the chronic SDH. CONCLUSIONS Overall, the presenting clinical and radiological characteristics of children with acute SDH and acute/chronic SDH caused by AHT did not differ, suggesting that repeated abuse, rather than spontaneous rebleeding, is the etiology of most acute SDH in children with chronic SDH. However, more severe neurological symptoms were more common among children with acute SDH. Children with acute/chronic SDH and asymptomatic macrocephaly have unique risks and distinct radiological and clinical characteristics.

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.

Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: Perfusion abnormalities in abusive head trauma

2017 ◽  
Vol 44 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Alex Mun-Ching Wong ◽  
Chih-Hua Yeh ◽  
Ho-Ling Liu ◽  
Tai-Wei Wu ◽  
Kuang-Lin Lin ◽  
...  
Keyword(s):  
Head Trauma ◽  
Perfusion Imaging ◽  
Arterial Spin Labeling ◽  
Abusive Head Trauma ◽  
Spin Labeling ◽  
Subdural Hemorrhage

Gender Differences in Characteristics and Outcome in Primary Intraventricular Hemorrhage

2019 ◽  
Vol 16 (4) ◽  
pp. 321-327
Author(s):  
Rui Guo ◽  
Lu Yin ◽  
Ruiqi Chen ◽  
Liang Zhou ◽  
Chao You ◽  
...  
Keyword(s):  
Gender Differences ◽  
Intraventricular Hemorrhage ◽  
Chronic Alcoholism ◽  
Monocyte Count ◽  
Rare Type ◽  
Acute Hydrocephalus ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
Gcs Score

Background: Primary intraventricular hemorrhage (PIVH) is a rare type of Intracerebral Hemorrhage (ICH), which is poorly understood. This study aimed to investigate gender differences in patients' characteristics, management and outcome at discharge and 90 days after PIVH. Methods: Consecutive patients with PIVH from a single center in China were enrolled over a 7- year period. Gender differences in demographics, risk factors, etiological subtypes, treatment, and outcomes were examined. The logistic regression models were used in the study to identify the predictors of poor outcome. Results: In total, 174 patients were analyzed, and 77 (44.3%) of them were women. Women with PIVH were younger (p = 0.047), with lower systolic and diastolic blood pressure (p = 0.02 and p = 0.004, respectively). They had more cases caused by Moyamoya disease (p = 0.038). There were fewer patients with hypertension (p = 0.008), smoking (p＜0.001), chronic alcoholism (p＜0.001), harbored lower hemoglobin (p＜0.001) and Absolute Monocyte Count (AMC) (p = 0.04) at admission compared with men. There were no differences between female and male patients regarding the mortality and poor outcome in the multivariable-adjusted models ((OR = 0.57; 95% CI, 0.15-2.14) and (OR = 0.86; 95% CI, 0.32-2.37), respectively). In subgroup analysis after adjustment, the gender specific independent predictors for unfavorable outcome were higher with a Graeb score (OR = 1.78; 95% CI, 1.01-3.13) or AMC (OR = 9.66; 95% CI, 1.20-12.87) in women, and lower Glasgow coma scale (GCS) score (OR = 0.64; 95% CI, 0.47-0.87) or acute hydrocephalus (OR = 0.17; 95% CI, 0.03-0.86) in men. Conclusions: Women with PIVH exhibit some distinctive baseline features compared with men. The gender difference of the PIVH does not appear to affect the neurological outcome. The predictors of poor outcomes are Graeb score and AMC in women and GCS score and acute hydrocephalus in men.

Abstract P384: Outcomes of Endovascular Therapy in Patients With Pre-Stroke Mobility Impairment

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rachel Beekman ◽  
Jie-Lena Sun ◽  
Brooke Alhanti ◽  
Lee H Schwamm ◽  
Eric Smith ◽  
...  
Keyword(s):  
Inpatient Rehabilitation ◽  
Stroke Severity ◽  
Limited Data ◽  
Mobility Impairment ◽  
Endovascular Thrombectomy ◽  
Stroke Registry ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
Get With The Guidelines

Background and Purpose: Patients with pre-stroke mobility impairment were excluded from endovascular clinical trials. There is limited data regarding safety and outcomes of endovascular thrombectomy (EVT) in this population. We used a large, national dataset (Get With The Guidelines (GWTG)-Stroke) to evaluate the safety and outcomes of EVT in patients with pre-stroke mobility impairment (PSMI). Methods: We included patients who underwent EVT in the GWTG-Stroke registry between 2015 and 2019. PSMI was defined as inability to ambulate independently and poor outcome was defined as in-hospital mortality or discharge to hospice. GEE logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56,762 patients treated with EVT, 2919 (5.14%) had PSMI. Patients with PSMI were older (median 79 [IQR 70-87] vs 70 [59-80], P<0.001), more likely to be female (63.4% vs 49.2%, P<0.001), had more medical comorbidities, presented with a higher NIHSS (19 [12-24] vs 15 [9-21], P<0.001), and were less likely to be treated with tPA (36.8% vs 45.6%, P<0.001). PSMI was not associated with intracranial hemorrhage but was associated with poor outcome (Table 1). Patients with PSMI with poor outcomes were more likely to be older (83 [74-89] vs 77 [68-86], P<0.001) and have a higher presenting NIHSS (21 [16-25] vs 16 [11-22], p<0.001). Forty-nine percent of patients with PSMI with age >80 years and NIHSS >20 had a poor outcome. Conclusions: Amongst patients with PSMI treated with EVT, two thirds survived and one third were discharged to home or to inpatient rehabilitation. Advanced age and increased stroke severity increased the likelihood of poor outcomes. EVT appears safe in patients with PSMI, yet further study of effectiveness in this population is warranted.

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.

Subdural hemorrhage in a cohort with cerebral sinovenous thrombosis: Application to abusive head trauma

2021 ◽  
Vol 117 ◽  
pp. 105119
Author(s):  
James Anderst ◽  
Shannon Carpenter ◽  
Terra Frazier ◽  
Brian Appavu ◽  
Michael Noetzel ◽  
...  
Keyword(s):  
Head Trauma ◽  
Abusive Head Trauma ◽  
Subdural Hemorrhage ◽  
Cerebral Sinovenous Thrombosis ◽  
Sinovenous Thrombosis

Abstract 96: What Critical Volume of Intraventricular Hemorrhage is Important in Intracerebral Haemorrhage? Interact2 Results

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Craig Anderson ◽  
Edward Chan ◽  
Xia Wang ◽  
Hisatomi Arima ◽  
Emma Heeley ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Linear Relation ◽  
Controlled Trial ◽  
Intraventricular Haemorrhage ◽  
Clinical Severity ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Threshold Volume ◽  
Clinically Significant ◽  
Poor Outcomes

Background and purpose: Intraventricular haemorrhage (IVH) predicts outcome in acute intracerebral haemorrhage (ICH), but there is uncertainty over the strength of association and what clinically relevant threshold volume is relevant to prognosis. We aimed to elucidate risk associations of IVH and outcome in participants of the INTERACT2 study. Methods: INTERACT2 was an international, multicenter, prospective, open, blinded endpoint, randomized controlled trial of 2839 patients with ICH (<6 hr) and elevated systolic BP (SBP) who were randomly assigned to intensive (target SBP <140mmHg) or guideline-based (SBP <180mmHg) BP management in 2008-2012. Associations of 740 (26%) patients with IVH on poor outcome (mRS >3) at 90 days, were determined in logistic regression models. Results: Patients with ICH-IVH were significantly older, had greater clinical severity, and more with prior ischemic stroke and deep and large hematoma volume, after adjustment for other variables. Poor outcome occurred in 67% of ICH-IVH patients compared with 49% of ICH-alone patients (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.42-0.60; p<0.01). There was a strong linear relation between ICH volume and poor outcome. Compared to lowest quartile (Q1) IVH volume (0-2.07mL), OR for poor outcomes increased in Q2 (2.08-5.84 mL) 0.74 (95%CI 0.46-1.18 mL), Q3 (5.97-13-74 ml) 1.27 (95%CI 0.78-2.06), and Q4 (13.82-117.55) 1.56 (95%CI 0.94-2.58), p trend 0.03. Associations were stronger for death, where a baseline IVH volume of 5-10mL emerging as a statistically (and clinically) significant threshold for risk. Conclusion: While a linear relation exists between IVH and outcome in ICH, a 5-10mL volume appears an appropriate cut-point for clinical-decisions over use of interventions with risk.

Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma

2018 ◽  
Vol 48 (13) ◽  
pp. 1915-1923 ◽  
Author(s):  
Meghann M. Ronning ◽  
Patrick L. Carolan ◽  
Gretchen J. Cutler ◽  
Richard J. Patterson
Keyword(s):  
Head Trauma ◽  
Abusive Head Trauma ◽  
Subdural Hemorrhage ◽  
Head Ct

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.

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