Abusive Head Trauma Has Deep, Prolonged Effect on Children

Marcia Frellick

November 17, 2014

More than half of children aged 0 to 4 years severely injured by abusive head trauma (AHT) will die before they turn 21 years old, according to new research published online November 17 in Pediatrics. The study also found that those children who were severely injured through AHT have a 55% reduction in health-related quality of life.

A related study, also published online November 17 in Pediatrics, validates a prediction tool designed to help clinicians identify victims of AHT.

In the first study, Ted R. Miller, PhD, from the Pacific Institute for Research and Evaluation, Calverton, Maryland, and colleagues asked caretakers or pediatricians to anonymously respond to a survey in 2009, using the online SurveyMonkey tool.

The researchers received responses regarding 170 survivors and found that AHT left 57% of the children blind or partially blind. Another 5% needed eye surgery, and 23% required a feeding tube after the injuries.

The authors note that most of the shaking or abuse happens before a child turns 1 year old. One in 14 cases results in death before hospital discharge.

Even Mild Abuse Worse Than Severe Burn

Researchers classified the severity of the injuries as mild (15.9% of cases), moderate (13.5%), and severe (70.6%). However, they found that even a mild AHT injury causes disability greater than that of a severe burn.

When they quantified the disability-adjusted life years (DALYs), or the sum of years of productive life lost to disability plus life-years lost to premature death, they estimated an average lifetime burden of 4.7 DALYs for mild AHT, 5.4 for moderate AHT, 24.1 for severe AHT, and 29.8 for deaths. On average, DALY loss for those who survived at least 30 days was 7.6 years of lost life expectancy and 5.7 years lived with disability.

The estimated toll from AHT in the United States in 2009 was 69,925 DALYs.

"These findings reinforce the significant challenge AHT cases pose for society and underline the potential benefits of effective prevention efforts. Thus, our findings strengthen the policy case for aggressive preventive intervention and for recognizing that perpetrators have committed a serious crime," Dr Miller and colleagues write.

Four Variables Good Predictors of AHT

In the second study, Kent Hymel, MD, from the Penn State Milton S. Hershey Medical Center, Department of Pediatrics, Division of Child Abuse Pediatrics, Hershey, Pennsylvania, and colleagues tested whether a four-part clinical prediction rule, developed by Pediatric Brain Injury Research Network investigators, would accurately identify AHT cases.

The prediction rule was develop for young children with head injuries admitted to the pediatric intensive care unit and includes these factors: acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages; and any skull fractures other than of a single, unilateral, nondiastatic, linear, or parietal variety.

In the newly studied patient population, the clinical prediction rule demonstrated sensitivity of 0.96, specificity of 0.46, positive predictive value of 0.55, and negative predictive value of 0.93.

Overall, the researchers found that the clinical prediction rule identified 98% of study patients who were later diagnosed with AHT.

The authors' work was supported by the Annie Casey Foundation and a Canada Research Chair in Community Child Health Research. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 17, 2014.


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