Journal
JOURNAL OF PAEDIATRICS AND CHILD HEALTH
Volume 56, Issue 4, Pages 615-621Publisher
WILEY
DOI: 10.1111/jpc.14700
Keywords
abusive head trauma; child; child abuse; head injury; infant
Categories
Funding
- National Health and Medical Research Council (Centre of Research Excellence for Paediatric Emergency Medicine), Canberra, Australia [GNT1046727, GNT1058560]
- Murdoch Children's Research Institute, Melbourne, Australia
- Emergency Medicine Foundation, Brisbane, Australia [EMPJ-11162]
- Perpetual Philanthropic Services, Australia [2012/1140]
- Auckland Medical Research Foundation, Auckland, New Zealand [3112011]
- A + Trust (Auckland District Health Board), Auckland, New Zealand
- WA Health Targeted Research Funds 2013, Perth, Australia
- Townsville Hospital, Townsville, Australia
- Health Service Private Practice Research and Education Trust Fund, Townsville, Australia
- Victorian Government's Infrastructure Support Program, Melbourne, Australia
- Royal Children's Hospital Foundation, Melbourne, Australia
- Melbourne Children's Clinician Scientist Fellowship, Melbourne, Australia
- NHMRC Practitioner Fellowship, Canberra, Australia
- Health Research Council of New Zealand [HRC13/556]
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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.
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