Original ArticleRisk Factors for Mortality in Children with Abusive Head Trauma
Section snippets
Methods
All procedures were approved by the Institutional Review Boards of the institutions involved. A database of children who had been diagnosed with unequivocal abusive head trauma by the Child Protection Team at 1 of 4 pediatric institutions (Nationwide Children's Medical Center [Columbus, Ohio], Seattle Children's Hospital/Harborview Medical Center [Seattle, Washington], Cincinnati Children's Hospital Medical Center [Cincinnati, Ohio], and Children's Hospital of Pittsburgh of UPMC [Pittsburgh,
Results
The inclusion and exclusion of children into this study is described in the Figure. The overall database contained 460 children. Exclusion of 74 children with no GCS score reported yielded a total of 386 children for bivariate analysis. An additional 28 children were excluded from the multivariable analysis because of individual missing data points. The mean age of all 386 included children was 9.6 ± 0.6 months and the mean initial GCS score was 10.6 ± 0.3 (Table I). Overall, 69 children died
Discussion
We found that incrementally decreased GCS scores, RH, intraparenchymal hemorrhage, and cerebral edema are independently associated with death in the hospital in children with abusive head trauma. In the subgroup of children with severe abusive head trauma and RH, mortality was associated with decreased initial GCS score and cerebral edema. Interestingly, chronic SDH was significantly associated with decreased mortality in this subgroup.
Knowledge of risk factors for mortality can aid clinicians
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Supported by the Matty Eappen Foundation, which had no role in study design, collection, analysis, and interpretation of data, the writing of the report, and the decision to submit for publication. The authors declare no conflicts of interest.