Background

Abusive head trauma (AHT) is a severe manifestation of physical abuse in young children. This study examines the outcome of AHT in children under 2 years and features associated with mortality and disability.

Methods

Retrospective chart review of 72 children under 2 years diagnosed to have AHT between 2011 and 2018 at a tertiary teaching hospital in Malaysia. Demographic variables, clinical features, results of neuroimaging and their associations with outcome were explored.

Results

The median age at presentation was 4 months, 78% were six months or younger and 68% were male. Two-thirds became unwell in the care of an alternative caregiver. Subdural hemorrhage was present in 98%. Mortality was 10%. Forty-nine survivors returned with median interval of 16 months (IQR 5–44 months) between discharge and last follow-up. At least 35% of 65 survivors were disabled with 29% having multiple disabilities. Multiple disabilities (61.1% versus 25.8%) and cognitive impairment (61.1% versus 22.6%) were significantly higher in children 3 years or older at last follow-up (p < 0.05). Signs of brainstem dysfunction at presentation, requirement for ventilation and hypoxic-ischemic injury on neuroimaging were associated with mortality. Needing ventilation, cerebral edema and neurological or visual impairment at discharge were associated with disability.

Conclusions

Outcomes of death or disability in 42% make prevention of AHT a public health priority. Survivors require long-term multi-disciplinary follow-up for coordination of rehabilitation and educational support. Prevention should be directed at improving resources and services to support families in the care of young infants under 6 months.

中文翻译：

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2 岁以下儿童虐待性头部创伤的结果：来自中等收入国家的单中心研究

背景

虐待性头部创伤 (AHT) 是幼儿身体虐待的严重表现。本研究检查了 2 岁以下儿童 AHT 的结果以及与死亡率和残疾相关的特征。

方法

对 2011 年至 2018 年间在马来西亚一家三级教学医院诊断为患有 AHT 的 72 名 2 岁以下儿童的回顾性图表回顾。探讨了人口统计学变量、临床特征、神经影像学结果及其与结果的关联。

结果

就诊时的中位年龄为 4 个月，78% 为 6 个月或以下，68% 为男性。三分之二的人在替代照顾者的照顾下感到不适。98%存在硬膜下出血。死亡率为 10%。49 名幸存者从出院到最后一次随访的中位间隔为 16 个月（IQR 5-44 个月）返回。65 名幸存者中至少有 35% 患有残疾，29% 患有多种残疾。在最后一次随访中，3 岁或以上儿童的多重残疾（61.1% 对 25.8%）和认知障碍（61.1% 对 22.6%）显着更高（p < 0.05)。就诊时脑干功能障碍的体征、通气需求和神经影像学缺氧缺血性损伤与死亡率相关。出院时需要通气、脑水肿和神经或视力障碍与残疾有关。

结论

42% 的死亡或残疾结果使预防 AHT 成为公共卫生优先事项。幸存者需要长期的多学科随访，以协调康复和教育支持。预防应着眼于改善资源和服务，以支持家庭照顾 6 个月以下的婴儿。