Citation

Nuño M, Ugiliweneza B, Bardini RL, Ozturk A, Stephenson JT, Magana JN. J. Trauma Acute Care Surg. 2019; ePub(ePub): ePub.

Affiliation

Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, USA.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002255

PMID

30865156

Abstract

BACKGROUND: Abusive head trauma (AHT) peaks during early infancy and decreases in toddler years. Infants and toddlers experience different injuries, possibly impacting the risk of mortality. We aimed to evaluate the association of age with mortality METHODS: We conducted a retrospective study of AHT hospitalizations in 2000, 2003, 2006, 2009, and 2012 from the Kid's Inpatient Claims Database (KID). An accidental head trauma cohort was included to hypothesize that the association between age and mortality is unique to abuse. A nested multivariable logistic regression was used to perform the analysis.

RESULTS: Children of age 2-4 experienced higher mortality than <2 (22% vs 10%, p<0.0001), adjusted OR 1.6 (95% CI: 1.1-2.2). The presence of subarachnoid hemorrhage (OR 1.9, 95% CI: 1.3-2.9), cerebral edema (OR 4.0, 95% CI: 2.9-5.4), and retinal hemorrhage (OR 1.9, 95% CI: 1.5-2.5) were associated with an increase risk in mortality. Children <2 experienced more fractures and hemorrhage (subdural, subarachnoid, retinal) while children age 2-4 encountered more internal injuries and cerebral edemaIn children with accidental head trauma, age 2-4 has a lower mortality compared to <2 year olds (OR 0.4, 95% CI: 0.3-0.6). Among children <2 years, AHT and accidental trauma had comparable risk of mortality (OR 0.9, 95% CI: 0.6-1.3). However, among 2-4 year olds, AHT had a higher risk of mortality than accidental trauma (OR 3.3, 95% CI: 2.1-5.1).

CONCLUSIONS: There is a considerable risk of mortality associated with age at diagnosis in children with AHT.Children <2 and those 2-4 year olds present with different types of injuries. The high risk of mortality in the 2-4 years old is unique to AHT. Efforts should be made to increase awareness about the risk of mortality and identify factors that can aide in a timely accurate diagnosis. LEVEL OF EVIDENCE: Level III, observational study.

Language: en