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Age-Related Mortality in Abusive Head Trauma

Nuño, Miriam PhD1; Ugiliweneza, Beatrice PhD, MSPH2; Bardini, Renee L. BS3; Ozturk, Arzu MD4; Stephenson, Jacob T. MD3,5; Magaña, Julia N. MD6

Journal of Trauma and Acute Care Surgery: March 8, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/TA.0000000000002255
PTS 2018 - Oral: PDF Only

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 edema

In 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.

1Department of Public Health Sciences, Division of Biostatistics, University of California Davis, USA

2Department of Neurosurgery, University of Louisville, Louisville, KY, USA

3Department of Surgery, University of California, Davis Medical Center, Sacramento, USA

4Department of Radiology, University of California, Davis Medical Center, Sacramento, USA

5Uniformed Services University of Health Sciences, Bethesda, MD

6Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, USA

Address Correspondence to: Miriam Nuño, PhD, Department of Public Health Sciences, Division of Biostatistics, University of California Davis One Shields Avenue, Med Sci 1C, Davis, CA, 95616, USA., 530-752-1409.

Funding Source: The authors have no funding source to report relevant to this article.

Financial Disclosure: The authors have no financial relationships relevant to this article to disclose.

Conflict of Interest: The authors have no conflict of interest to disclose.

Meetings where this work has been presented: 5th Annual Meeting of the pediatric Trauma Society, November 8-10, 2018 in Houston, TX

© 2019 Lippincott Williams & Wilkins, Inc.