TY - JOUR
T1 - The association of subcortical brain injury and abusive head trauma
AU - Pediatric Brain Injury Research Network (PediBIRN) Investigators
AU - Even, Katelyn M.
AU - Hymel, Kent P.
AU - Armijo-Garcia, Veronica
AU - Musick, Matthew
AU - Weeks, Kerri
AU - Haney, Suzanne B.
AU - Marinello, Mark
AU - Herman, Bruce E.
AU - Frazier, Terra N.
AU - Carroll, Christopher L.
AU - Liang, Menglu
AU - Wang, Ming
N1 - Funding Information:
The authors would like to thank the remaining PediBIRN investigators who helped to capture the data used in this secondary analysis: Antoinette Laskey, MD, MPH (Primary Children's Medical Center, Salt Lake City, UT); Douglas F. Willson, MD and Robin Foster, MD (The Children's Hospital of Richmond, Richmond, VA); Sandeep K. Narang, MD, JD (University of Texas Health Sciences Center at San Antonio, San Antonio, TX); Deborah A. Pullin, BSN, APRN (Dartmouth-Hitchcock Medical Center, Lebanon, NH); Jeanine M. Graf, MD and Reena Isaac, MD (Texas Children's Hospital, Houston, TX); Kelly Tieves, MD (Children's Mercy Hospital, Kansas City, MO); Edward Truemper, MD (Children's Hospital of Omaha, Omaha, NE); Lindall E. Smith, MD (Wesley Medical Center, Wichita, KS); Renee A. Higgerson, MD and George A. Edwards, MD (Dell Children's Medical Center of Central Texas, Austin, TX); Nancy S. Harper, MD, FAAP and Karl L. Serrao, MD, FAAP, FCCM (Driscoll Children's Hospital, Corpus Christi, TX); Andrew Sirotnak, MD, Joseph Albietz, MD, and Antonia Chiesa, MD (Children's Hospital Colorado, Denver, CO); Christine McKiernan, MD (Baystate Medical Center, Springfield, MA); Mark S. Dias, MD (Penn State College of Medicine, Hershey, PA); Michael Stoiko, MD, Debra Simms, MD, FAAP, and Sarah J. Brown, DO, FACOP, FAAP (Helen DeVos Children's Hospital, Grand Rapids, MI); Amy Ornstein, MD, FRCPC (IWK Health Centre, Halifax, Nova Scotia) and Phil Hyden, MD (Children's Hospital of Central California, Madera, CA). This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number P50HD089922). Additional support was provided by Dartmouth-Hitchcock Medical Center, a private family foundation, The Gerber Foundation, Penn State University, and The Penn State Clinical & Translational Research Institute, Pennsylvania State University CTSA (NIH/CTSA grant number UL1 TR002014). The National Institutes of Health, Pennsylvania State University, and other funding agencies had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Pennsylvania State University.
Funding Information:
This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number P50HD089922 ). Additional support was provided by Dartmouth-Hitchcock Medical Center , a private family foundation, The Gerber Foundation , Penn State University , and The Penn State Clinical & Translational Research Institute, Pennsylvania State University CTSA (NIH/CTSA grant number UL1 TR002014 ).
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/12
Y1 - 2022/12
N2 - Background: Abusive head trauma (AHT) remains a major pediatric problem with diagnostic challenges. A small pilot study previously associated subcortical brain injury with AHT. Objectives: To investigate the association of subcortical injury on neuroimaging with the diagnosis of AHT. Participants and setting: Children <3 years with acute TBI admitted to 18 PICUs between 2011 and 2021. Methods: Secondary analysis of existing, combined, de-identified, cross-sectional dataset. Results: Deepest location of visible injury was characterized as scalp/skull/epidural (n = 170), subarachnoid/subdural (n = 386), cortical brain (n = 170), or subcortical brain (n = 247) (total n = 973). Subcortical injury was significantly associated with AHT using both physicians' diagnostic impression (OR: 8.41 [95 % CI: 5.82–12.44]) and a priori definitional criteria (OR: 5.99 [95 % CI: 4.31–8.43]). Caregiver reports consistent with the child's gross motor skills and historically consistent with repetition decreased as deepest location of injury increased, p < 0.001. Patients with subcortical injuries were significantly more likely to have traumatic extracranial injuries such as rib fractures (OR 3.36, 95 % CI 2.30–4.92) or retinal hemorrhages (OR 5.97, 95 % CI 4.35–8.24), respiratory compromise (OR 12.12, 95 % CI 8.49–17.62), circulatory compromise (OR 6.71, 95 % CI 4.87–9.29), seizures (OR 3.18, 95 % CI 2.35–4.29), and acute encephalopathy (OR 12.44, 95 % CI 8.16–19.68). Conclusions: Subcortical injury is associated with a diagnosis of AHT, historical inaccuracies concerning for abuse, traumatic extracranial injuries, and increased severity of illness including respiratory and circulatory compromise, seizures, and prolonged loss of consciousness. Presence of subcortical injury should be considered as one component of the complex AHT diagnostic process.
AB - Background: Abusive head trauma (AHT) remains a major pediatric problem with diagnostic challenges. A small pilot study previously associated subcortical brain injury with AHT. Objectives: To investigate the association of subcortical injury on neuroimaging with the diagnosis of AHT. Participants and setting: Children <3 years with acute TBI admitted to 18 PICUs between 2011 and 2021. Methods: Secondary analysis of existing, combined, de-identified, cross-sectional dataset. Results: Deepest location of visible injury was characterized as scalp/skull/epidural (n = 170), subarachnoid/subdural (n = 386), cortical brain (n = 170), or subcortical brain (n = 247) (total n = 973). Subcortical injury was significantly associated with AHT using both physicians' diagnostic impression (OR: 8.41 [95 % CI: 5.82–12.44]) and a priori definitional criteria (OR: 5.99 [95 % CI: 4.31–8.43]). Caregiver reports consistent with the child's gross motor skills and historically consistent with repetition decreased as deepest location of injury increased, p < 0.001. Patients with subcortical injuries were significantly more likely to have traumatic extracranial injuries such as rib fractures (OR 3.36, 95 % CI 2.30–4.92) or retinal hemorrhages (OR 5.97, 95 % CI 4.35–8.24), respiratory compromise (OR 12.12, 95 % CI 8.49–17.62), circulatory compromise (OR 6.71, 95 % CI 4.87–9.29), seizures (OR 3.18, 95 % CI 2.35–4.29), and acute encephalopathy (OR 12.44, 95 % CI 8.16–19.68). Conclusions: Subcortical injury is associated with a diagnosis of AHT, historical inaccuracies concerning for abuse, traumatic extracranial injuries, and increased severity of illness including respiratory and circulatory compromise, seizures, and prolonged loss of consciousness. Presence of subcortical injury should be considered as one component of the complex AHT diagnostic process.
KW - Abusive head trauma
KW - Diagnosis
KW - Traumatic brain injury
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U2 - 10.1016/j.chiabu.2022.105917
DO - 10.1016/j.chiabu.2022.105917
M3 - Article
C2 - 36308893
AN - SCOPUS:85140468645
SN - 0145-2134
VL - 134
JO - Child Abuse and Neglect
JF - Child Abuse and Neglect
M1 - 105917
ER -