Risk Factors for Mortality in Children with Abusive Head Trauma
Date
2012
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Publisher
The Journal of Pediatrics
Abstract
Objective: We sought to identify risk factors for mortality in a large clinical cohort of children with abusive head trauma. Study design: Bivariate analysis and multivariable logistic regression models identified demographic, physical examination and radiologic findings associated with in-hospital mortality of children with abusive head trauma at four pediatric centers. An initial Glasgow Coma Scale (GCS) ≤ 8 defined severe abusive head trauma. Data are shown as OR (95% CI). Results: Analysis included 386 children with abusive head trauma. Multivariable analysis showed children with initial GCS either 3 or 4 – 5 had increased mortality versus children with GCS 12 – 15 (OR 57.8 [12.1 – 277.6] and 15.6 [2.6 – 95.1], respectively, p < 0.001). Additionally, retinal hemorrhage (RH), intraparenchymal hemorrhage and cerebral edema were independently associated with mortality. In the subgroup with severe abusive head trauma and RH (n = 117), cerebral edema and initial GCS of 3 or 4 – 5 were independently associated with mortality. Chronic subdural hematoma was independently associated with survival. Conclusions: Low initial GCS score, RH, intraparenchymal hemorrhage and cerebral edema are independently associated with mortality in abusive head trauma. Knowledge of these risk factors may enable researchers and clinicians to improve the care of these vulnerable children. (Author Abstract)
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Keywords
child abuse, physical abuse, brain injury, fatality, death, research
Citation
Shein, S. L., Bell, M. J., Kochanek, P. M., Tyler-Kabara, E. C., Wisniewski, S. R., Feldman, K., ... & Berger, R. P. (2012). Risk factors for mortality in children with abusive head trauma. The Journal of pediatrics, 161(4), 716-722.