Risk Factors for Mortality in Children with Abusive Head Trauma

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• 作者：Steven L. Shein ; MD¹ ; ² ; ^{drstevenshein@gmail.com} ; Michael J. Bell ; MD¹ ; ² ; ³ ; Patrick M. Kochanek ; MD¹ ; ² ; Elizabeth C. Tyler-Kabara ; MD ; PhD³ ; ⁴ ; ⁵ ; Stephen R. Wisniewski ; PhD⁶ ; Kenneth Feldman ; MD⁷ ; Kathi Makoroff ; MD⁸ ; Philip V. Scribano ; DO ; MSCE⁹ ; Rachel P. Berger ; MD ; MPH² ; ¹⁰
• 关键词：EDH ; Epidural hematoma ; GCS ; Glasgow Coma Scale ; SAH ; Subarachnoid hemorrhage ; SDH ; Subdural hematoma ; TBI ; Traumatic brain injury ; RH ; Retinal hemorrhage ; CT ; Computed tomography
• 刊名：The Journal of Pediatrics
• 出版年：2012
• 出版时间：October, 2012
• 年：2012
• 卷：161
• 期：4
• 页码：716-722.e1
• 全文大小：410 K

文摘

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Objective

We sought to identify risk factors for mortality in a large clinical cohort of children with abusive head trauma.

Study design

Bivariate analysis and multivariable logistic regression models identified demographic, physical examination, and radiologic findings associated with in-hospital mortality of children with abusive head trauma at 4 pediatric centers. An initial Glasgow Coma Scale (GCS) ¡Ü8 defined severe abusive head trauma. Data are shown as OR (95 % CI).

Results

Analysis included 386 children with abusive head trauma. Multivariable analysis showed children with initial GCS either 3 or 4-5 had increased mortality vs children with GCS 12-15 (OR = 57.8; 95 % CI, 12.1-277.6 and OR = 15.6; 95 % CI, 2.6-95.1, respectively, P < .001). Additionally, retinal hemorrhage (RH), intraparenchymal hemorrhage, and cerebral edema were independently associated with mortality. In the subgroup with severe abusive head trauma and RH (n = 117), cerebral edema and initial GCS of 3 or 4-5 were independently associated with mortality. Chronic subdural hematoma was independently associated with survival.

Conclusions

Low initial GCS score, RH, intraparenchymal hemorrhage, and cerebral edema are independently associated with mortality in abusive head trauma. Knowledge of these risk factors may enable researchers and clinicians to improve the care of these vulnerable children.