Pediatric Abusive Head Trauma: ThinkFirst National Injury Prevention Foundation. (16th November 2020)

• Record Type: Journal Article
• Authors: Wilson, Taylor A; Gospodarev, Vadim; Minasian, Tanya
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_587
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Pediatric abusive head trauma (AHT) represents 80% of nonaccidental trauma (NAT) deaths and remains a leading cause of death among patients younger than 2 years old. Neurosurgical intervention can ameliorate damage from secondary injury but not from primary injury. Thus, prevention through increased public awareness is imperative. METHODS: This is a retrospective review of pediatric AHT patients presenting to our hospital from 2016–2019. SPSS was used for data analysis. RESULTS: AHT is increasing over time ( P < .001) with a mortality of nearly 10%. On multivariate analysis, lower GCS ( P < .001) and SDH ( P = .017) are most predictive of neurosurgical intervention, and lower GCS ( P < .001), SDH ( P = .020), and lack of skull fracture ( P = .045) are most predictive of lower functional outcome. Additionally, the economic burden of AHT is high, as patients often require ICU level care, long hospital stays, and extensive rehabilitation. Multivariate analysis of hospital charges revealed that neurosurgical intervention ( P < .001), cranioplasty ( P < .001), longer ICU stay ( P < .001), longer total length of stay ( P < .001), not surviving ( P < .001), craniotomy/craniectomy ( P = .017), and EVD/ICP monitor placement ( P = .045) are most predictive of increased charges. Medicaid pays for nearly 80% of these patients. CONCLUSION: AHT patients represent a unique population that will benefit from multidisciplinary efforts to increase public awareness and educate parents and caregivers about prevention.