Mechanisms, Clinical Presentations, Injuries, and Outcomes From Inflicted Versus Noninflicted Head Trauma During Infancy: Results of a Prospective, Multicentered, Comparative Study

Hymel, Kent P.; Makoroff, Kathi L.; Laskey, Antoinette L.; Conaway, Mark R.; Blackman, James A.

doi:10.1542/peds.2006-3111

Cited by 102 publications

(57 citation statements)

References 38 publications

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“…To date, hypoxic-ischemic injury is not completely understood and is probably a result of complex factors (concussion, edema, axonal and/or brainstem injury, concomitant strangulation, etc) or other causes of global neurologic dysfunction that may result from shaking. [15][16][17] No admission was made during the infants' hospitalization. All the declarations came from legal statements (police custody and investigations), sometimes after a subsequent forensic investigation.…”

Section: Discussionmentioning

confidence: 99%

Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking

et al. 2010

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OBJECTIVE: Confessions are uncommon in abusive head trauma (AHT) cases, and there is debate over whether shaking alone can cause the injuries characteristic of AHT. The objective of this article is to correlate legal statements by perpetrators with medical documentation to offer insights into the mechanism of injury. METHODS:In this retrospective observational study we examined forensic evidence from 112 cases referred for AHT over a 7-year period. We compared 29 cases in which a perpetrator confessed to violence toward the child with 83 cases in which there was no confession. Inclusion criteria were subdural hematoma (SDH) on computed tomography and perpetrator admission of a causal relationship between the violence inflicted and the child's symptoms. Groups were compared by using Student's t test for age and Fisher's exact test for gender, death, fractures, retinal hemorrhages, ecchymoses, symptoms, and SDH patterns. All medical records from birth to diagnosis, imaging studies, and written investigation reports were reviewed. RESULTS:All confessions came from forensic investigations. There was no statistically significant difference between the 2 groups for any of the variables studied. Shaking was described as extremely violent (100%) and was repeated (55%) from 2 to 30 times (mean: 10) because it stopped the infant's crying (62.5%). Impact was uncommon (24%). No correlation was found between repeated shaking and SDH densities. CONCLUSIONS:This unique forensic case series confirms the violence of shaking. The high frequency of habitual AHT is a strong argument for reporting suspected cases to judicial authorities and helps to explain the difficulty in dating the injuries.

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Section: Discussionmentioning

confidence: 99%

Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking

et al. 2010

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“…The higher mean ISS in the youngest age group was not unexpected because this age group will encompass a majority of the children admitted with abusive head trauma that often have poor outcomes. 29 Of particular interest was the increase in the ISS over the study period, which may be traced to several sources. First, the proportion of children covered by public or no insurance has increased over time, perhaps suggesting greater economic strains and stress on social support services for families in need.…”

Section: Discussionmentioning

confidence: 99%

Trends in Hospitalization Rates and Severity of Injuries From Abuse in Young Children, 1997–2009

Farst

Ambadwar²,

King³

et al. 2013

Pediatrics

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OBJECTIVES: To examine trends in incidence of hospitalizations for injury from abuse in young children from 1997 through 2009 and to examine injury severity trends. METHODS: Cases were identified in the National Inpatient Sample database of the Healthcare Cost and Utilization Project by using International Classification of Diseases, Ninth Revision, Clinical Modification codes for child maltreatment and external cause of injury for assault in children aged 0 through 3 years. Incidence was calculated by age, gender, and region. Trends in incidence of hospitalization and injury severity were calculated over time. RESULTS: Hospitalization rates for injury from abuse showed no significant change over the study period, ranging from a low of 2.10 per 10 000 children in 1998 to a high of 3.01 per 10 000 children in 2005 (P = .755). Children aged <1 had significantly higher hospitalization rates for injury from abuse (6.01 vs 1.12, P <.001) and higher mean injury severity scores compared with children aged 1 to 3 years (12.50, SD = 0.14 vs 8.56, SD = 0.21, P <.001). Injury severity scores increased significantly over the study period. CONCLUSIONS: No significant change in hospitalization rates for injury from abuse among young children was observed from 1997 to 2009. These results coincide with other reports of stable or modestly increasing rates of serious physical abuse or death in young children but not with reports from child welfare data showing declines in physical abuse during the same period. Diverse sources of data may provide important complementary methods to track child abuse.

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“…Formulated by the lead author, these criteria mirror or replicate the criteria used in other peer-reviewed studies. [16][17][18] To minimize circular reasoning, they contain no references to specific intracranial injuries, to injury severity, or to any of the 4 predictor variables included in the AHT CPR. Patients meeting $1 of these criteria were sorted as having AHT.…”

Section: Outcome Measurementioning

confidence: 99%

Validation of a Clinical Prediction Rule for Pediatric Abusive Head Trauma

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Pediatric Brain Injury Research Network investigators recently derived a highly sensitive clinical prediction rule for pediatric abusive head trauma (AHT). WHAT THIS STUDY ADDS:The performance of this AHT screening tool has been validated. Four clinical variables, readily available at the time of admission, detect pediatric AHT with high sensitivity in intensive care settings. abstract BACKGROUND AND OBJECTIVE: To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population. METHODS:We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely headinjured children ,3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR. RESULTS:In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT.CONCLUSIONS: Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHT with high sensitivity in young, acutely head-injured children admitted to the PICU. Pediatrics 2014;134:e1537-e1544

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Mechanisms, Clinical Presentations, Injuries, and Outcomes From Inflicted Versus Noninflicted Head Trauma During Infancy: Results of a Prospective, Multicentered, Comparative Study

Abstract: Compared with infants with noninflicted head trauma, young victims of inflicted head trauma experience more frequent noncontact injury mechanisms that result in deeper brain injuries, cardiorespiratory compromise, diffuse cerebral hypoxia-ischemia, and worse outcomes.

Cited by 102 publications

References 38 publications

Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking

Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking

Trends in Hospitalization Rates and Severity of Injuries From Abuse in Young Children, 1997–2009

Validation of a Clinical Prediction Rule for Pediatric Abusive Head Trauma

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