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

Westrick, Ashly C.; Moore, Marjorie; Monk, Steve; Greeno, Amber; Shannon, Chevis N.

doi:10.1159/000430846

Cited by 6 publications

(2 citation statements)

References 17 publications

(37 reference statements)

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“…While not required for diagnosis, retinal hemorrhages have been reported in up to 85% of AHT victims, and tend to be diffuse and bilateral, involving all layers of the retina (56). Subdural hemorrhages have been reported in >70% of AHT victims (45,57,58). Specific neuroimaging patterns were further described by Kemp et al in 2011: multiple SDH over the convexity, interhemispheric hemorrhages, posterior fossa SDH, hypoxic-ischemic injury (HII), and cerebral edema were significantly associated with AHT (59).…”

Section: Diagnosing Aht Clinical Featuresmentioning

confidence: 96%

Advances and Future Directions of Diagnosis and Management of Pediatric Abusive Head Trauma: A Review of the Literature

2020

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Abusive head trauma (AHT) is broadly defined as injury of the skull and intracranial contents as a result of perpetrator-inflicted force and represents a persistent and significant disease burden in children under the age of 4 years. When compared to age-matched controls with typically single occurrence accidental traumatic brain injury (TBI), mortality after AHT is disproportionately high and likely attributable to key differences between injury phenotypes. This article aims to review the epidemiology of AHT, summarize the current state of AHT diagnosis, treatment, and prevention as well as areas for future directions of study. Despite neuroimaging advances and an evolved understanding of AHT, early identification remains a challenge for contemporary clinicians. As such, the reported incidence of 10-30 per 100,000 infants per year may be a considerable underestimate that has not significantly decreased over the past several decades despite social campaigns for public education such as "Never Shake a Baby." This may reflect caregivers in crisis for whom education is not sufficient without support and intervention, or dangerous environments in which other family members are at risk in addition to the child. Acute management specific to AHT has not advanced beyond usual supportive care for childhood TBI, and prevention and early recognition remain crucial. Moreover, AHT is frequently excluded from studies of childhood TBI, which limits the precise translation of important brain injury research to this population. Repeated injury, antecedent abuse or neglect, delayed medical attention, and high rates of apnea and seizures on presentation are important variables to be considered. More research, including AHT inclusion in childhood TBI studies with comparisons to age-matched controls, and translational models with clinical fidelity are needed to better elucidate the pathophysiology of AHT and inform both clinical care and the development of targeted therapies. Clinical prediction rules, biomarkers, and imaging modalities hold promise, though these have largely been developed and validated in patients after clinically evident AHT has already occurred. Nevertheless, recognition of warning signs and intervention before irreversible harm occurs remains the current best strategy for medical professionals to protect vulnerable infants and toddlers.

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Section: Diagnosing Aht Clinical Featuresmentioning

confidence: 96%

Advances and Future Directions of Diagnosis and Management of Pediatric Abusive Head Trauma: A Review of the Literature

2020

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“…As only mild symptoms, such as fussiness and drowsiness, can be presenting symptoms of AHT, health care providers should maintain a high index of suspicion. Severe symptoms, such as seizure and apnea, with the provision of a relatively mild injury mechanism, such as slipping on the bath floor, should raise suspicion regarding child abuse, including AHT [ 56 , 58 , 65 ].…”

Section: Clinical Featuresmentioning

confidence: 99%

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective

Kwak

2022

J Korean Neurosurg Soc

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Abusive head trauma (AHT) is the most severe form of physical abuse in children. Such injury involves traumatic damage to the head and/or spine of infants and young children. The term AHT was introduced to include a wider range of injury mechanisms, such as intentional direct blow, throw, and even penetrating trauma by perpetuator(s). Currently, it is recommended to replace the former term, shaken baby syndrome, which implicates shaking as the only mechanism, with AHT to include diverse clinical and radiological manifestations. The consequences of AHT cause devastating medical, social and financial burdens on families, communities, and victims. The potential harm of AHT to the developing brain and spinal cord of the victims is tremendous. Many studies have reported that the adverse effects of AHT are various and serious, such as blindness, mental retardation, physical limitation of daily activities and even psychological problems. Therefore, appropriate vigilance for the early recognition and diagnosis of AHT is highly recommended to stop and prevent further injuries. The aim of this review is to summarize the relevant evidence concerning the early recognition and diagnosis of AHT. To recognize this severe type of child abuse early, all health care providers maintain a high index of suspicion and vigilance. Such suspicion can be initiated with careful and thorough history taking and physical examinations. Previously developed clinical prediction rules can be helpful for decision-making regarding starting an investigation when considering meaningful findings. Even the combination of biochemical markers may be useful to predict AHT. For a more confirmative evaluation, neuroradiological imaging is required to find AHT-specific findings. Moreover, timely consultation with ophthalmologists is needed to find a very specific finding, retinal hemorrhage.

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Update on Non-accidental Trauma

Song

Jain

2022

Pediatric Ophthalmology

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

Cited by 6 publications

References 17 publications

Advances and Future Directions of Diagnosis and Management of Pediatric Abusive Head Trauma: A Review of the Literature

Advances and Future Directions of Diagnosis and Management of Pediatric Abusive Head Trauma: A Review of the Literature

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective

Update on Non-accidental Trauma

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