Document Detail

Medical, social and societal issues in infants with abusive head trauma.
MedLine Citation:
PMID:  20486311     Owner:  NLM     Status:  MEDLINE    
Abusive head trauma (AHT) is the leading cause of death from traumatic brain injury in under 2 year olds. AHT presents with acute encephalopathy, subdural hemorrhages and retinal hemorrhages occurring in the context of an inappropriate or inconsistent history. We retrospectively analyzed, over a 10 year period, admissions and transfers to our hospital with suspected AHT to assess patterns of presentation, presenting symptoms, investigations, subsequent confirmation, social work input and both neurological and social outcomes. We analyzed all suspected AHT infants and children looking for the time of presentation, presenting symptoms, caregivers concerns prior to presentation, a family profile including stressors, investigations (in particular neuroradiology and ophthalmology assessments), treatment in hospital, length of stay in hospital, social work involvement, subsequent discharge, neurological outcome and subsequent social work follow up. Data was collected from the hospital HIPE system, RIS (radiology reports system) and records from the social work department from a period October 1998 to January 2009 inclusive. Of 22 patients with confirmed AHT, ages seizures and irritability followed by vomiting, poor feeding, a bulging fontanelle and lethargy. The father was the sole minder in 5 cases. There was a delayed history in 4 cases. One had multiple visits to his GP. All cases had subdural hemorrhages proven by either CT or MRI scans and retinal hemorrhages diagnosed by ophthalmology. One infant presented with a torn frenulum. Four had suspicious bruising. All had normal coagulation profiles, skeletal surveys and extensive metabolic tests. Hospital stays ranged from 1 to 124 days (the median was 28 days and mean 33 days). Ten (45%) infants required ventilatory support. Sixteen infants had social work involvement within 4 days of admission (7 of these were interviewed immediately). Outcomes after case conferences were that 6 returned home with parents, 9 were placed in foster care. Four parents (18%) admitted to shakng their infants. There was 1 death. Thirteen (60%) were normal on follow up. Two had ADHD. Two had language delay. Two had motor delay. One criminal prosecution has ensued as yet Children with suspected AHT should undergo appropriate investigations which should include brain imaging, ophthalmic examination, skeletal survey and blood investigations. Early social work assessment is a priority as part of the multidisciplinary approach. A prospective national study of AHT is required.
S Koe; B Price; S May; L Kyne; P Keenan; M McKay; A J Nicholson
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Irish medical journal     Volume:  103     ISSN:  0332-3102     ISO Abbreviation:  Ir Med J     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0430275     Medline TA:  Ir Med J     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  102-5     Citation Subset:  IM    
Children's University Hospital, Temple Street, Dublin 1.
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MeSH Terms
Brain Diseases / epidemiology
Child Abuse / diagnosis,  statistics & numerical data*
Craniocerebral Trauma* / diagnosis,  epidemiology
Hematoma, Subdural / epidemiology
Retinal Hemorrhage / epidemiology
Retrospective Studies

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