• Camille L Stewart, Courtenay M Holscher, Ernest E Moore, Micheal Bronsert, Steven L Moulton, David A Partrick, and Denis D Bensard.
• University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: Camille.Stewart@ucdenver.edu.
• J. Pediatr. Surg. 2013 Oct 1; 48 (10): 2106-11.

Background/PurposeChildren suffering from abusive head trauma (AHT) have worse outcomes compared to non-AHT, but the reasons for this are unclear. We hypothesized that delayed medical care associated with AHT causes prolonged pre-hospital hypotension and hypoxia as measured by admission base deficit (BD), and that this would correlate with outcome.MethodsWe performed a 10-year retrospective chart review of children admitted for AHT at two academic level-I trauma centers. Statistics were performed using Student's t test, chi-square analysis, and multivariate logistic regression, and considered significant at p < 0.05.ResultsFour-hundred twelve children with AHT were identified, and admission BD was drawn for 148/412 (36%) children, including 104 survivors and 44 non-survivors. Non-survivors had significantly higher BD compared to survivors (12.6 ± 1.6 versus 5.3 ± 0.6, p < 0.001). Non-survivors were more likely to be intubated pre-hospital and get cardiopulmonary resuscitation (CPR) (p < 0.001). Mortality increased with rising BD, according to CPR status. There was no difference in patterns of brain injury between survivors and non-survivors (p > 0.05).ConclusionsBD correlates with mortality in children suffering severe AHT. Non-survivors are also more likely to be intubated pre-hospital and require CPR, with no difference in pattern of brain injury, suggesting that secondary injury is a major determinant of outcome in severe AHT.Copyright © 2013 Elsevier Inc. All rights reserved.

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