• Elisabeth Guenther, Annie Powers, Rajendu Srivastava, and Joshua L Bonkowsky.
• Division of Pediatric Emergency Medicine, University of Utah, School of Medicine, Salt Lake City, UT 84158, USA. Guenther@hsc.utah.edu
• J. Pediatr. 2010 Nov 1;157(5):821-5.

ObjectiveTo identify rates of abusive head trauma and associated clinical risk factors in patients with an apparent life-threatening event (ALTE).Study DesignRetrospective study of infants, 0 to 12 months, admitted for an apparent life-threatening event (ALTE; 1999-2003). Patients with abusive head trauma were identified at presentation or on follow-up; statistical analysis identified characteristics associated with abusive head trauma.ResultsOf 627 patients with ALTE, 48% were male. Nine (1.4%) were diagnosed with abusive head trauma, of whom 5 were diagnosed in the emergency department. All cases detected in the emergency department had physical examination findings indicative of abusive head trauma. Patient age, male sex, or ethnicity were not significantly different between those with and without abusive head trauma. More children with abusive head trauma had a documented 911 call (56% vs 22%, P = .029), vomiting (56% vs 19%, P = .018), or irritability (22% vs 3%, P = .033). Multivariate analysis revealed odds ratio for abusive head trauma were 4.9 with a 911 call (P = .037), 5.3 with vomiting (P = .024), and 11.9 with irritability (P = .0197).ConclusionsAbusive head trauma is in the differential for infants with an ALTE, although almost half of the cases are missed by current emergency department management. Vomiting, irritability, or a call to 911 are significantly associated with heightened risk for abusive head trauma.Copyright © 2010 Mosby, Inc. All rights reserved.

13 keywords...

hide…