[P3-159] Parenchymal injuries as a predictive factor in abusive head trauma
[Introduction]
Abusive head trauma is the most common cause of fatality and long-term morbidity in non-accidental injury. We use parenchymal injuries as a predicting factor of neurological outcome and mortality in abusive head trauma.
[Methodology]
We retrospectively evaluated hospitalized pediatric patients younger than 5 years old, and clinically suspected of abusive head trauma in a tertiary referral hospital during October 2000 to April 2010. Computed tomography or magnetic resonance imaging finding of brain were reviewed by radiologist and pediatric neurologist. Acute parenchymal injuries included ischemia, swelling and midline shifting were reviewed. The primary outcome was evaluated using rate of developmental delay and cerebral palsy; and the secondary outcome was measured by mortality rate and hospital length of stay.
[Results]
There were 52 patients (32 males, 20 females) in abusive head trauma identified. The average age was 7.3 months (range, 0.9 – 37 month). Average glascow coma scale was 10.37, 44 (84.6%) need intensive care monitoring and 23 (44.2%) received neural surgery to relieve hematoma. Overall, 18(34.6%) patients had ischemia change with loss of gray-white matter differentiating. Ischemia and swelling changes were associated with higher rate of cerebral palsy (6/9[66.7] vs 6/30[20%], p = 0.014) and developmental delay (6/8[75%] vs 8/27[29.6%], p = 0.039). Also, ischemic changes were associated with higher rate of mortality (5/18[27.8%] vs 2/34[5.9%]) and hospital length of stay (34.6 days vs 18.9 days, p = 0.043).
[Conclusions]
Acute parenchymal injuries findings of ischemia change indicate poorer neurological outcome, increased mortality rate and hospital length of stay.
Abusive head trauma is the most common cause of fatality and long-term morbidity in non-accidental injury. We use parenchymal injuries as a predicting factor of neurological outcome and mortality in abusive head trauma.
[Methodology]
We retrospectively evaluated hospitalized pediatric patients younger than 5 years old, and clinically suspected of abusive head trauma in a tertiary referral hospital during October 2000 to April 2010. Computed tomography or magnetic resonance imaging finding of brain were reviewed by radiologist and pediatric neurologist. Acute parenchymal injuries included ischemia, swelling and midline shifting were reviewed. The primary outcome was evaluated using rate of developmental delay and cerebral palsy; and the secondary outcome was measured by mortality rate and hospital length of stay.
[Results]
There were 52 patients (32 males, 20 females) in abusive head trauma identified. The average age was 7.3 months (range, 0.9 – 37 month). Average glascow coma scale was 10.37, 44 (84.6%) need intensive care monitoring and 23 (44.2%) received neural surgery to relieve hematoma. Overall, 18(34.6%) patients had ischemia change with loss of gray-white matter differentiating. Ischemia and swelling changes were associated with higher rate of cerebral palsy (6/9[66.7] vs 6/30[20%], p = 0.014) and developmental delay (6/8[75%] vs 8/27[29.6%], p = 0.039). Also, ischemic changes were associated with higher rate of mortality (5/18[27.8%] vs 2/34[5.9%]) and hospital length of stay (34.6 days vs 18.9 days, p = 0.043).
[Conclusions]
Acute parenchymal injuries findings of ischemia change indicate poorer neurological outcome, increased mortality rate and hospital length of stay.