Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study
Aim Abusive 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. Methods This was a planned secondary analysis of a prospective multicentre cohort study...
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| Veröffentlicht in: | Journal of paediatrics and child health 2020-04, Vol.56 (4), p.615-621 |
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| creator | Babl, Franz E Pfeiffer, Helena Kelly, Patrick Dalziel, Stuart R Oakley, Ed Borland, Meredith L Kochar, Amit Dalton, Sarah Cheek, John A Gilhotra, Yuri Furyk, Jeremy Lyttle, Mark D Bressan, Silvia Donath, Susan Hearps, Stephen J C Smith, Anne Crowe, Louise |
| description | Aim
Abusive 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.
Methods
This was a planned secondary analysis of a prospective multicentre cohort study of head injured children aged |
| doi_str_mv | 10.1111/jpc.14700 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2324916907</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2391796368</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3880-2da101ebf8dc4c8a501987b0a5461e94bef2f78a574ea34653e889a7e7daccf23</originalsourceid><addsrcrecordid>eNp1kLtOwzAUhi0EoqUw8ALIEgsMae3EiR22quKqSnSAOXKcE5oqN3wB5e1xaWFAwot9jj59-v0jdE7JlPoz2_RqShkn5ACNKWMkoDxmh_5NIhYwQckInRizIYSEcSyO0SiiIqSJoGOUryQUlbS6UljmzlQfgNcgC2y1dI3EVYvtGjA0oN-gVQMuoJfaNtDaGzzHjattpfygAfe6Mz0ou1Wobt1pi411xXCKjkpZGzjb3xP0enf7sngIls_3j4v5MlCRECQIC0kJhbwUhWJKyJjQVPCcyJglFFKWQxmW3O85AxmxJI5AiFRy4IVUqgyjCbraeX2QdwfGZk1lFNS1bKFzJgujkKU0SQn36OUfdNM53fp0nkopT5MoEZ663lHK_8xoKLNeV43UQ0ZJti0-88Vn38V79mJvdHkDxS_507QHZjvgs6ph-N-UPa0WO-UX-_yNQw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2391796368</pqid></control><display><type>article</type><title>Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Babl, Franz E ; Pfeiffer, Helena ; Kelly, Patrick ; Dalziel, Stuart R ; Oakley, Ed ; Borland, Meredith L ; Kochar, Amit ; Dalton, Sarah ; Cheek, John A ; Gilhotra, Yuri ; Furyk, Jeremy ; Lyttle, Mark D ; Bressan, Silvia ; Donath, Susan ; Hearps, Stephen J C ; Smith, Anne ; Crowe, Louise</creator><creatorcontrib>Babl, Franz E ; Pfeiffer, Helena ; Kelly, Patrick ; Dalziel, Stuart R ; Oakley, Ed ; Borland, Meredith L ; Kochar, Amit ; Dalton, Sarah ; Cheek, John A ; Gilhotra, Yuri ; Furyk, Jeremy ; Lyttle, Mark D ; Bressan, Silvia ; Donath, Susan ; Hearps, Stephen J C ; Smith, Anne ; Crowe, Louise ; Paediatric Research in Emergency Departments International Collaborative (PREDICT) ; the Paediatric Research in Emergency Departments International Collaborative (PREDICT)</creatorcontrib><description>Aim
Abusive 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.
Methods
This 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.
Results
AHT 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).
Conclusions
Emergency 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.</description><identifier>ISSN: 1034-4810</identifier><identifier>EISSN: 1440-1754</identifier><identifier>DOI: 10.1111/jpc.14700</identifier><identifier>PMID: 31821681</identifier><language>eng</language><publisher>Australia: John Wiley & Sons Australia, Ltd</publisher><subject>abusive head trauma ; Adolescent ; Australia - epidemiology ; Child ; child abuse ; Child Abuse - diagnosis ; Cohort analysis ; Cohort Studies ; Coma ; Consciousness ; Craniocerebral Trauma - diagnosis ; Craniocerebral Trauma - epidemiology ; Craniocerebral Trauma - etiology ; Emergency Service, Hospital ; Fainting ; Head injuries ; head injury ; Health risk assessment ; Humans ; Infant ; Intensive care ; New Zealand - epidemiology ; Pediatrics ; Prospective Studies</subject><ispartof>Journal of paediatrics and child health, 2020-04, Vol.56 (4), p.615-621</ispartof><rights>2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)</rights><rights>2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).</rights><rights>2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3880-2da101ebf8dc4c8a501987b0a5461e94bef2f78a574ea34653e889a7e7daccf23</citedby><cites>FETCH-LOGICAL-c3880-2da101ebf8dc4c8a501987b0a5461e94bef2f78a574ea34653e889a7e7daccf23</cites><orcidid>0000-0002-3615-3821 ; 0000-0002-1107-2187</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjpc.14700$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjpc.14700$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31821681$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Babl, Franz E</creatorcontrib><creatorcontrib>Pfeiffer, Helena</creatorcontrib><creatorcontrib>Kelly, Patrick</creatorcontrib><creatorcontrib>Dalziel, Stuart R</creatorcontrib><creatorcontrib>Oakley, Ed</creatorcontrib><creatorcontrib>Borland, Meredith L</creatorcontrib><creatorcontrib>Kochar, Amit</creatorcontrib><creatorcontrib>Dalton, Sarah</creatorcontrib><creatorcontrib>Cheek, John A</creatorcontrib><creatorcontrib>Gilhotra, Yuri</creatorcontrib><creatorcontrib>Furyk, Jeremy</creatorcontrib><creatorcontrib>Lyttle, Mark D</creatorcontrib><creatorcontrib>Bressan, Silvia</creatorcontrib><creatorcontrib>Donath, Susan</creatorcontrib><creatorcontrib>Hearps, Stephen J C</creatorcontrib><creatorcontrib>Smith, Anne</creatorcontrib><creatorcontrib>Crowe, Louise</creatorcontrib><creatorcontrib>Paediatric Research in Emergency Departments International Collaborative (PREDICT)</creatorcontrib><creatorcontrib>the Paediatric Research in Emergency Departments International Collaborative (PREDICT)</creatorcontrib><title>Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study</title><title>Journal of paediatrics and child health</title><addtitle>J Paediatr Child Health</addtitle><description>Aim
Abusive 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.
Methods
This 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.
Results
AHT 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).
Conclusions
Emergency 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.</description><subject>abusive head trauma</subject><subject>Adolescent</subject><subject>Australia - epidemiology</subject><subject>Child</subject><subject>child abuse</subject><subject>Child Abuse - diagnosis</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Coma</subject><subject>Consciousness</subject><subject>Craniocerebral Trauma - diagnosis</subject><subject>Craniocerebral Trauma - epidemiology</subject><subject>Craniocerebral Trauma - etiology</subject><subject>Emergency Service, Hospital</subject><subject>Fainting</subject><subject>Head injuries</subject><subject>head injury</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Infant</subject><subject>Intensive care</subject><subject>New Zealand - epidemiology</subject><subject>Pediatrics</subject><subject>Prospective Studies</subject><issn>1034-4810</issn><issn>1440-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kLtOwzAUhi0EoqUw8ALIEgsMae3EiR22quKqSnSAOXKcE5oqN3wB5e1xaWFAwot9jj59-v0jdE7JlPoz2_RqShkn5ACNKWMkoDxmh_5NIhYwQckInRizIYSEcSyO0SiiIqSJoGOUryQUlbS6UljmzlQfgNcgC2y1dI3EVYvtGjA0oN-gVQMuoJfaNtDaGzzHjattpfygAfe6Mz0ou1Wobt1pi411xXCKjkpZGzjb3xP0enf7sngIls_3j4v5MlCRECQIC0kJhbwUhWJKyJjQVPCcyJglFFKWQxmW3O85AxmxJI5AiFRy4IVUqgyjCbraeX2QdwfGZk1lFNS1bKFzJgujkKU0SQn36OUfdNM53fp0nkopT5MoEZ663lHK_8xoKLNeV43UQ0ZJti0-88Vn38V79mJvdHkDxS_507QHZjvgs6ph-N-UPa0WO-UX-_yNQw</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Babl, Franz E</creator><creator>Pfeiffer, Helena</creator><creator>Kelly, Patrick</creator><creator>Dalziel, Stuart R</creator><creator>Oakley, Ed</creator><creator>Borland, Meredith L</creator><creator>Kochar, Amit</creator><creator>Dalton, Sarah</creator><creator>Cheek, John A</creator><creator>Gilhotra, Yuri</creator><creator>Furyk, Jeremy</creator><creator>Lyttle, Mark D</creator><creator>Bressan, Silvia</creator><creator>Donath, Susan</creator><creator>Hearps, Stephen J C</creator><creator>Smith, Anne</creator><creator>Crowe, Louise</creator><general>John Wiley & Sons Australia, Ltd</general><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3615-3821</orcidid><orcidid>https://orcid.org/0000-0002-1107-2187</orcidid></search><sort><creationdate>202004</creationdate><title>Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study</title><author>Babl, Franz E ; Pfeiffer, Helena ; Kelly, Patrick ; Dalziel, Stuart R ; Oakley, Ed ; Borland, Meredith L ; Kochar, Amit ; Dalton, Sarah ; Cheek, John A ; Gilhotra, Yuri ; Furyk, Jeremy ; Lyttle, Mark D ; Bressan, Silvia ; Donath, Susan ; Hearps, Stephen J C ; Smith, Anne ; Crowe, Louise</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3880-2da101ebf8dc4c8a501987b0a5461e94bef2f78a574ea34653e889a7e7daccf23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>abusive head trauma</topic><topic>Adolescent</topic><topic>Australia - epidemiology</topic><topic>Child</topic><topic>child abuse</topic><topic>Child Abuse - diagnosis</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Coma</topic><topic>Consciousness</topic><topic>Craniocerebral Trauma - diagnosis</topic><topic>Craniocerebral Trauma - epidemiology</topic><topic>Craniocerebral Trauma - etiology</topic><topic>Emergency Service, Hospital</topic><topic>Fainting</topic><topic>Head injuries</topic><topic>head injury</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Infant</topic><topic>Intensive care</topic><topic>New Zealand - epidemiology</topic><topic>Pediatrics</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Babl, Franz E</creatorcontrib><creatorcontrib>Pfeiffer, Helena</creatorcontrib><creatorcontrib>Kelly, Patrick</creatorcontrib><creatorcontrib>Dalziel, Stuart R</creatorcontrib><creatorcontrib>Oakley, Ed</creatorcontrib><creatorcontrib>Borland, Meredith L</creatorcontrib><creatorcontrib>Kochar, Amit</creatorcontrib><creatorcontrib>Dalton, Sarah</creatorcontrib><creatorcontrib>Cheek, John A</creatorcontrib><creatorcontrib>Gilhotra, Yuri</creatorcontrib><creatorcontrib>Furyk, Jeremy</creatorcontrib><creatorcontrib>Lyttle, Mark D</creatorcontrib><creatorcontrib>Bressan, Silvia</creatorcontrib><creatorcontrib>Donath, Susan</creatorcontrib><creatorcontrib>Hearps, Stephen J C</creatorcontrib><creatorcontrib>Smith, Anne</creatorcontrib><creatorcontrib>Crowe, Louise</creatorcontrib><creatorcontrib>Paediatric Research in Emergency Departments International Collaborative (PREDICT)</creatorcontrib><creatorcontrib>the Paediatric Research in Emergency Departments International Collaborative (PREDICT)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of paediatrics and child health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Babl, Franz E</au><au>Pfeiffer, Helena</au><au>Kelly, Patrick</au><au>Dalziel, Stuart R</au><au>Oakley, Ed</au><au>Borland, Meredith L</au><au>Kochar, Amit</au><au>Dalton, Sarah</au><au>Cheek, John A</au><au>Gilhotra, Yuri</au><au>Furyk, Jeremy</au><au>Lyttle, Mark D</au><au>Bressan, Silvia</au><au>Donath, Susan</au><au>Hearps, Stephen J C</au><au>Smith, Anne</au><au>Crowe, Louise</au><aucorp>Paediatric Research in Emergency Departments International Collaborative (PREDICT)</aucorp><aucorp>the Paediatric Research in Emergency Departments International Collaborative (PREDICT)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study</atitle><jtitle>Journal of paediatrics and child health</jtitle><addtitle>J Paediatr Child Health</addtitle><date>2020-04</date><risdate>2020</risdate><volume>56</volume><issue>4</issue><spage>615</spage><epage>621</epage><pages>615-621</pages><issn>1034-4810</issn><eissn>1440-1754</eissn><abstract>Aim
Abusive 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.
Methods
This 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.
Results
AHT 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).
Conclusions
Emergency 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.</abstract><cop>Australia</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>31821681</pmid><doi>10.1111/jpc.14700</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3615-3821</orcidid><orcidid>https://orcid.org/0000-0002-1107-2187</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | abusive head trauma Adolescent Australia - epidemiology Child child abuse Child Abuse - diagnosis Cohort analysis Cohort Studies Coma Consciousness Craniocerebral Trauma - diagnosis Craniocerebral Trauma - epidemiology Craniocerebral Trauma - etiology Emergency Service, Hospital Fainting Head injuries head injury Health risk assessment Humans Infant Intensive care New Zealand - epidemiology Pediatrics Prospective Studies |
| title | Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study |
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