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Disability and visual outcomes following suspected abusive head trauma in children under 2 years
  1. Juliana Wright1,
  2. Sally Painter2,
  3. Sheethal Sujayeendra Kodagali1,
  4. Nicholas R Jones3,
  5. Andrea Roalfe3,
  6. Sandeep Jayawant4,
  7. John Elston5,
  8. Geetha Anand1
  1. 1Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2Paediatric Ophthalmology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  3. 3Nuffield Department of Primary Care Health Sciences, Oxford, Oxfordshire, UK
  4. 4Paediatric Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  5. 5Paediatric Ophthalmology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Juliana Wright, Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; juliana.wright{at}


Aim To report disability and visual outcomes following suspected abusive head trauma (AHT) in children under 2 years.

Methods We present a retrospective case series (1995–2017) of children with suspected AHT aged ≤24 months. King’s Outcome Score of Childhood Head Injury (KOSCHI) was used to assess disability outcomes at hospital discharge and at follow-up. The study used a retinal haemorrhage score (RHS) to record findings at presentation and a visual outcome score at follow-up.

Results We included 44 children (median age 16 weeks). At presentation, 98% had a subdural haemorrhage and 93% had a retinal haemorrhage. At discharge, 61% had moderate-to-severe disability, and 34% a good recovery. A higher RHS was observed in those with more disability (r=−0.54, p=0.0002). At follow-up, 14% had a worse KOSCHI score (p=0.055). 35% children had visual impairment, including 9% with no functional vision. Those with poorer visual function had a higher RHS (r=0.53, p=0.003). 28% attended mainstream school without support; 50% were in foster care or had been adopted, 32% lived with birth mother and 18% with extended family.

Conclusion It is known that injuries from suspected AHT result in high levels of morbidity; our cohort showed significant rates of disability and visual impairment. Those with higher disability at discharge and poorer visual function showed more significant retinal changes. The extent of disability was not always apparent at hospital discharge, impacting on provision of prognostic information and targeted follow-up.

  • child abuse
  • general paediatrics
  • neurodisability
  • ophthalmology

Statistics from


  • Contributors JE, NRJ, SJ and GA planned and designed the study, including the ethics application. Ophthalmic data analysis and interpretation by SP and JE. Overall data collection by SSK, JE and GA. GA and JE critically revised the manuscript. Statistical analysis by SP, JW and AR. Paper written by JW, with all authors approving the final paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The NHS Health Research Authority approved this retrospective cohort study, with ethical approval granted from the London-Hampstead Research Ethics Committee (reference 16/LO/2133).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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