Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study

Dı́az-Olavarrieta, Claudia; García-Piña, Corina Araceli; Loredo-Abdalá, Arturo; Paz, Francisco; García, Sandra G.; Schilmann, Astrid

doi:10.1016/j.chiabu.2011.05.017

Cited by 8 publications

(7 citation statements)

References 36 publications

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“…In contrast to most AHT cohorts, we found a female predominance in the population of AHT (3, 15, 16, 23, 24, 28–30). We found one other study that showed a female predominance in AHT (31). Our study differed from others in the literature in that included children all had ICP monitors placed – which may have altered the relationship between gender and AHT in some unexplained manner.…”

Section: Discussionmentioning

confidence: 66%

“…This could be explained by the younger age of children with AHT and their proximity in age to their physiological hemoglobin nadir (6 - 8 weeks of age). Others have shown a decrease in hematocrit associated with AHT, and this finding was shown to be an important component to a decision rule in diagnosing AHT (31, 39, 40). There was no difference in neurological exam except for the lowest recorded GCS score, which was decreased in the AHT group.…”

Section: Discussionmentioning

confidence: 92%

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Abusive Head Trauma and Mortality–An Analysis From an International Comparative Effectiveness Study of Children With Severe Traumatic Brain Injury

Ferguson

Sarnaik

Miles

et al. 2017

Critical Care Medicine

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Objectives Small series have suggested that outcomes after abusive head trauma (AHT) are less favorable than after other injury mechanisms. We sought to determine the impact of AHT on mortality and identify factors that differentiate children with AHT from those with TBI from other mechanisms. Design First 200 subjects from the Approaches and Decisions in Acute Pediatric TBI (ADAPT) Trial – a comparative effectiveness study using an observational, cohort study design. Setting Pediatric intensive care units in tertiary children’s hospitals in USA and abroad. Participants Consecutive children (age <18 y) with severe TBI (GCS ≤ 8; intracranial pressure (ICP) monitoring). Interventions None Measurements and Main Results Demographics, injury-related scores, prehospital and resuscitation events were analyzed. Children were dichotomized based on likelihood of AHT. A total of 190 children were included (n = 35 with AHT). AHT subjects were younger (1.87 y ± 0.32 vs. 9.23 y ± 0.39, p < 0.001) and a greater proportion were female (54.3% vs. 34.8%, p = 0.032). AHT were more likely to (i) be transported from home (60.0% vs. 33.5%, p < 0.001), (ii) have apnea (34.3% vs. 12.3%, p = 0.002) and (iii) seizures (28.6% vs. 7.7%, p < 0.001) during pre-hospital care. AHT had a higher incidence of seizures during resuscitation (31.4 vs. 9.7%, p = 0.002). After adjusting for covariates, there was no difference in mortality (AHT, 25.7% vs. non-AHT, 18.7%, HR 1.758, p = 0.60). A similar proportion died due to refractory intracranial hypertension in each group (AHT, 66.7% vs. non-AHT, 69.0%). Conclusion In this large, multicenter series, children with AHT had differences in prehospital and in-hospital secondary injuries which could have therapeutic implications. Unlike other TBI populations in children, female predominance was seen in AHT in our cohort. Similar mortality rates and refractory ICP deaths suggest that children with severe AHT may benefit from therapies including invasive monitoring and adherence to evidenced-based guidelines.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 92%

Abusive Head Trauma and Mortality–An Analysis From an International Comparative Effectiveness Study of Children With Severe Traumatic Brain Injury

Ferguson

Sarnaik

Miles

et al. 2017

Critical Care Medicine

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“…Subdural kanama, çocuk ya da yetişkinin ölümüne neden olan kafa travmasının en önemli bulgusu olup [35,39], dural sinuslerin veya yüzeyel kortikal venlerin yırtılması sonucu dura ile araknoid zar arasına gerçekleşen kanamadır [40]. Meksika'da yapılan bir çalışmada çocuklara yönelik istismara bağlı kafa travması olgularının %38'inin ölümle sonuçlandığı bildirilmiştir [41].…”

Section: Discussionunclassified

Two Physical Child Abuse Cases with Lethal Outcome [Olumle Sonuclanan Iki Fiziksel Cocuk Istismari Olgusu]

Erkol¹,

Cantürk²,

Erkol³

2014

Med-Science

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“…Previous studies indicate that children with AHT appear to have more severe consequences than children with similar severity, non-abusive injuries [17,18]. Approximately 7–30% of infants with AHT die, 30–50% experience significant neurological and cognitive deficits, and up to 30% have long-term adverse effects [19,20]. …”

Section: Introductionmentioning

confidence: 99%

Characteristics and Trends of Hospitalized Pediatric Abuse Head Trauma in Wuhan, China: 2002–2011

Xia

Xiang

Shao

et al. 2012

IJERPH

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This study investigated characteristics and trends of hospitalized abuse-related traumatic brain injuries (TBI) treated at a large pediatric medical center in Wuhan, China during the past 10 years. De-identified hospital discharge data for patients 0–4 years old hospitalized at the Wuhan Medical Care Center for Women and Children were analyzed, and ICD-10 codes were used to identify cases of TBI. Medical notes provided by doctors in the medical record were used to identify TBI cases in which suspected child abuse was the cause. From 2002 to 2011, 3,061 pediatric TBI patients were hospitalized and 4.6% (140) of these cases were suspected child abuse-related. The majority of suspected child abuse cases involved children younger than 1 year of age (68.6%) and usually affected males (63.6%). Children with non-Abusive Head Trauma (AHT) were more likely to have full recovery outcome (68.4%, 95% CI: 66.6%–70.0%) than children with suspected AHT (44.3%, 95% CI: 36.1%–52.5%). The proportion of all childhood TBI attributable to abuse did not appear to have increased in the 10-year period at this medical center. This is the first comprehensive study highlighting the important role of suspected child abuse in causing TBIs among Chinese children. Child abuse as a major cause of TBIs among infants in China should be studied further, and there should be greater awareness of this important social and medical problem in China.

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Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study

Cited by 8 publications

References 36 publications

Abusive Head Trauma and Mortality–An Analysis From an International Comparative Effectiveness Study of Children With Severe Traumatic Brain Injury

Abusive Head Trauma and Mortality–An Analysis From an International Comparative Effectiveness Study of Children With Severe Traumatic Brain Injury

Two Physical Child Abuse Cases with Lethal Outcome [Olumle Sonuclanan Iki Fiziksel Cocuk Istismari Olgusu]

Characteristics and Trends of Hospitalized Pediatric Abuse Head Trauma in Wuhan, China: 2002–2011

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