• Sonia Ajmera, Mustafa Motiwala, Matt Weeks, Chesney S Oravec, David S Hersh, Brittany D Fraser, Brandy Vaughn, and Paul Klimo.
• College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
• Neurosurgery. 2020 Sep 15; 87 (4): 803-810.

BackgroundThe spectrum of injury severity for abusive head trauma (AHT) severity is broad, but outcomes are unequivocally worse than accidental trauma. There are few publications that analyze different outcomes of AHT.ObjectiveTo determine variables associated with different outcomes of AHT.MethodsPatients were identified using our AHT database. Three different, but not mutually exclusive, outcomes of AHT were modeled: (1) death or hemispheric stroke (diffuse loss of grey-white differentiation); (2) stroke(s) of any size; and (3) need for a neurosurgical operation. Demographic and clinical variables were collected and correlations to the 3 outcomes of interest were identified using bivariate and multivariable analysis.ResultsFrom January 2009 to December 2017, 305 children were identified through a prospectively maintained AHT database. These children were typically male (60%), African American (54%), and had public or no insurance (90%). A total of 29 children (9.5%) died or suffered a massive hemispheric stroke, 57 (18.7%) required a neurosurgical operation, and 91 (29.8%) sustained 1 or more stroke. Death or hemispheric stroke was statistically associated with the pupillary exam (odds ratio [OR] = 45.7) and admission international normalized ratio (INR) (OR = 17.3); stroke was associated with the pupillary exam (OR = 13.2), seizures (OR = 14.8), admission hematocrit (OR = 0.92), and INR (9.4), and need for surgery was associated with seizures (OR = 8.6).ConclusionWe have identified several demographic and clinical variables that correlate with 3 clinically applicable outcomes of abusive head injury.Copyright © 2020 by the Congress of Neurological Surgeons.

18 keywords...

hide…