To better understand the natural history of post-stroke apathy, the authors tested 96 patients undergoing acute rehabilitation for stroke using the Apathy Inventory (AI). 28% of patients had apathy, and their AI scores improved on average 1 point by week 2 and 2 points by week 3 with the majority apathetic at discharge. Apathy severity correlated with aphasia, weakness, and impaired cognition, but not with depression. The findings suggest that acute rehabilitation is an optimal setting for clinical trials for post-stroke apathy because apathy is associated with poor outcomes and shows only a small degree of spontaneous improvement.

BACKGROUND AND OBJECTIVES: Child maltreatment (CM) is recognized as a major public health concern, and an important number of children suffer injuries related to abuse and neglect that result in death. We sought to identify risk factors for CM fatalities among hospitalized children that can provide clinicians with information to recognize at-risk children and reduce further death. METHODS:In this study, we included cases from the 2012 Kids' Inpatient Database with diagnosis codes related to CM who were ,5 years of age and were not transferred to another facility. Potential demographic and clinical risk factors were identified and compared to child fatality in the hospital by using bivariate and multivariate analyses. To assess how cases coded specifically for maltreatment differed from similar cases that only suggested maltreatment, a reduced-model multivariable logistic regression for fatality was created. RESULTS:We found 10 825 children ,5 years who had inpatient diagnoses coded in their medical record for CM. Most demographic variables (age, race, and sex) were not significantly associated with fatality, whereas clinical variables (transferring in, drowning, ingestions, and burns) were significantly associated with fatality. There were regional differences on the basis of hospital location as well as significantly more chronic conditions, procedure charges, and longer lengths of stay among children who died. Controlling for significant risk factors, those with diagnoses specific for physical abuse had ∼3 times the odds of dying (odds ratio 5 2.797; 95% confidence interval: 1.941-4.031). CONCLUSIONS:In this study, although infancy and decreased income were associated with increased risk for fatality, more important factors were the types of injuries the child endured and whether the inpatient clinician had identified specific injuries indicating physical abuse.

The authors tested the hypothesis that wrist-worn actimeters can quantify the severity of post-stroke apathy. The authors studied 57 patients admitted to an acute rehabilitation unit for ischemic or hemorrhagic stroke. After accounting for motor deficit of the affected arm and age, each increment of Apathy Inventory correlated with 5.6 fewer minutes moving per hour. The overall statistical model had an R2 of only 0.341, suggesting unexplained factors for total movement time. Wrist-worn actimeters may serve as an objective, quantifiable measure of post-stroke apathy in patients with an intact upper extremity, but cannot alone be used to diagnose apathy.

Objectives: Abusive head trauma (AHT) is the leading cause of death from trauma in children less than 2 years of age. A delay in presentation for care has been reported as a risk factor for abuse; however, there has been limited research on this topic. We compare children diagnosed with AHT to children diagnosed with accidental head trauma to determine if there is a delay in presentation. Methods:We retrospectively studied children less than 6 years old who had acute head injury and were admitted to the pediatric intensive care unit at a pediatric hospital from 2013 to 2017. Cases were reviewed to determine the duration from symptom onset to presentation to care and the nature of the head injury (abusive vs accidental).Results: A total of 59 children met inclusion criteria. Patients who had AHT were significantly more likely to present to care more than 30 minutes after symptom onset (P = 0.0015). Children who had AHT were more likely to be younger (median, 4 vs 31 months; P < 0.0001) and receive Medicaid (P < 0.0001) than those who had accidental head trauma. Patients who had AHT were more likely to have a longer length of stay (median, 11 vs 3 days; P < 0.0001) and were less likely to be discharged home than patients who had accidental head trauma (38% vs 84%; P = 0.0005). Conclusions:Children who had AHTwere more likely to have a delayed presentation for care as compared with children whose head trauma was accidental. A delay in care should prompt clinicians to strongly consider a workup for abusive injury.

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