Abusive Head Trauma

Abstract

Abusive head trauma has a robust and interesting scientific history. Recently, the American Academy of Pediatrics has endorsed a change in terminology to a term that is more general in describing the vast array of abusive mechanisms that can result in pediatric head injury. Simply defined, abusive head trauma is "child physical abuse that results in injury to the head or brain." Abusive head trauma is a relatively common cause of childhood neurotrauma, with an estimated incidence of 16 to 33 cases per 100,000 children per year in the first 2 years of life. Clinical findings are variable; AHT should be considered in all children with neurologic signs and symptoms, especially if no or only mild trauma is described. Subdural and retinal hemorrhages are the most common findings. The current best evidence-based literature has identified some features--apnea and severe retinal hemorrhages--that reliably discriminate abusive from accidental injury. Longitudinal studies of outcomes in abusive head trauma patients demonstrate that approximately one-third of the children are severely disabled, one third of them are moderately disabled, and one third have no or only mild symptoms. Abusive head trauma cases are complex cases that require a rigorous, multidisciplinary team approach. The clinician can establish this diagnosis with confidence if he/she maintains a high index of suspicion for the diagnosis, has knowledge of the signs, symptoms, and risk factors of abusive head trauma, and reasonably excludes other etiologies on the differential diagnosis.

Identifying Characteristics in Abusive Head Trauma: A Single-Institution Experience

“…In addition, retinal hemorrhages and subdural hematomas could be indicative of a more severe injury. In our cohort, we found that retinal hemorrhages and subdural hematomas were frequent, which is concordant with previous literature [14,15]. Approximately 57% of our cohort presented with retinal hemorrhages, which is lower than the rate of about three fourths that has been commonly cited in other literature [7].…”

“…Retinal hemorrhages and subdural hematomas are often associated with AHT with retinal hemorrhages being reported in 74-82% of AHT patients and subdural hematomas being reported in 77-90% of AHT patients [14]. In addition, retinal hemorrhages and subdural hematomas could be indicative of a more severe injury.…”

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

“…Therefore, remote reading of Ret Cam photographs could be a promising future strategy for detecting children with AHT (49). A psychosocial team should work with pediatricians to evaluate social risk factors of AHT and protection measures (13). Progress in research on the medical diagnosis of AHT has been remarkable, while the development of treatment strategies has been limited.…”

Occult Head Injury

“…Mental status changes, nausea and vomiting, difficulty breathing, excessive crying, other bone fractures, and retinal hemorrhage are indicators of possible brain injury and suggest screening should occur (Paul and Adamo 2014). Infants, very young children, and children presenting from lower socioeconomic households have higher risk for occult head injury (Narang and Clarke 2014). Children with challenging developmental or medical histories are also at greater risk (Paul and Adamo 2014).…”

“…Symptoms may be subtle, particularly early on, and the mechanism of injury may not be reported by the patient or collateral, particularly if the injury was due to abuse or neglect (Christian et al 2009;Narang and Clarke 2014;Paul and Adamo 2014). Mental status changes, nausea and vomiting, difficulty breathing, excessive crying, other bone fractures, and retinal hemorrhage are indicators of possible brain injury and suggest screening should occur (Paul and Adamo 2014).…”