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J Paediatr Child Health. 2019 Dec 10. doi: 10.1111/jpc.14700. [Epub ahead of print]

Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study.

Author information

1
Emergency department, Royal Children's Hospital, Melbourne, Victoria, Australia.
2
Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
3
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
4
Emergency department, Starship Children's Health, Auckland, New Zealand.
5
University of Auckland, Auckland, New Zealand.
6
Emergency department, Perth Children's Hospital, Perth, Western Australia, Australia.
7
Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
8
Emergency department, Women's & Children's Hospital, Adelaide, South Australia, Australia.
9
Emergency department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
10
Emergency department, Monash Medical Centre, Melbourne, Victoria, Australia.
11
Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
12
Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
13
Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
14
Emergency Department, Bristol Royal Hospital for Children, Bristol, United Kingdom.
15
Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom.
16
Department of Women's and Children's Health, University of Padova, Padova, Italy.
17
Victorian Forensic Paediatric Medical Service, Royal Children's Hospital, Melbourne, Victoria, Australia.

Abstract

AIM:

Abusive head trauma (AHT) is associated with high morbidity and mortality. We aimed to describe characteristics of cases where clinicians suspected AHT and confirmed AHT cases and describe how they differed.

METHODS:

This was a planned secondary analysis of a prospective multicentre cohort study of head injured children aged <18 years across five centres in Australia and New Zealand. We identified cases of suspected AHT when emergency department clinicians raised suspicion on a clinical report form or based on research assistant-assigned epidemiology codes. Cases were categorised as AHT positive, negative and indeterminate after multidisciplinary review. Suspected and confirmed AHT and non-AHT cases were compared using odds ratios with 95% confidence intervals.

RESULTS:

AHT was suspected in 70 of 13 371 (0.5%) head-injured children. Of these, 23 (32.9%) were categorised AHT positive, 18 (25.7%) AHT indeterminate and 29 (27.1%) AHT negative. Median age was 0.8 years in suspected, 1.4 years in confirmed AHT and 4.1 years in non-AHT cases. Odds ratios (95% confidence interval) for presenting features and outcomes in confirmed AHT versus non-AHT were: loss of consciousness 2.8 (1.2-6.9), scalp haematoma 3.9 (1.7-9.0), seizures 12.0 (4.0-35.5), Glasgow coma scale ≤12 30.3 (11.8-78.0), abnormal neuroimaging 38.3 (16.8-87.5), intensive care admission 53.4 (21.6-132.5) and mortality 105.5 (22.2-500.4).

CONCLUSIONS:

Emergency department presentations of children with suspected and confirmed AHT had higher rates of loss of consciousness, scalp haematomas, seizures and low Glasgow coma scale. These cases were at increased risk of abnormal computed tomography scans, need for intensive care and death.

KEYWORDS:

abusive head trauma; child; child abuse; head injury; infant

PMID:
31821681
DOI:
10.1111/jpc.14700

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