• Franz E Babl, Helena Pfeiffer, Patrick Kelly, Stuart R Dalziel, Ed Oakley, Meredith L Borland, Amit Kochar, Sarah Dalton, John A Cheek, Yuri Gilhotra, Jeremy Furyk, Mark D Lyttle, Silvia Bressan, Susan Donath, Hearps Stephen J C SJC Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia., Anne Smith, Louise Crowe, and Paediatric Research in Emergency Departments International Collaborative (PREDICT).
• Emergency department, Royal Children's Hospital, Melbourne, Victoria, Australia.
• J Paediatr Child Health. 2020 Apr 1; 56 (4): 615-621.

AimAbusive 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.MethodsThis 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.ResultsAHT 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).ConclusionsEmergency 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.© 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

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