Age-Related Mortality in Abusive Head Trauma
Miriam A. Nuno, PhD1; Beatrice Ugiliweneza, PhD2; James Bugni, PhD3; Renee Bardini, B.S.4
1University of California Davis, Davis, CA; 2Department of Neurosurgery, University of Louisville, Louisville, KY, USA, Louisville, KY; 3Independent, Davis, CA; 4UC Davis Medical Center, Department of Surgery, Sacramento, CA
Introduction: Incidence of abusive head trauma (AHT) peaks during early infancy and decreases in older toddler years. Mortality is estimated between 11%-36% under the age of 5. Evidence suggests that infants and older toddlers experience very difference types of injuries resulting from AHT.
Objective: To test the hypothesis that children who experience AHT during older toddler years (2-4) have an increased risk of mortality compared to infants (<2).
Design: Retrospective study of AHT hospital discharges in 2000, 2003, 2006, 2009, and 2012 from the Kid's Inpatient Database (KID). Multivariable logistic regression was used to evaluate the association between age and mortality.
Main Outcome Measure: In-hospital mortality.
Results: Children age 2-4 experienced a 21.6% mortality compared to 10.4% among those <2 years (p<.0001). After controlling for several confounders, older toddlers had an increased risk of mortality compared to infants (OR 1.49, 95% CI: 1.05-2.10). We evaluated the effect of age and mortality in a cohort of children with accidental head trauma and found that mortality decreases with age in children with accidental trauma (OR 0.4, 95% CI: 0.3-0.6). Furthermore, AHT synergistically increased the risk of mortality to a greater degree in 2-4 year-olds (OR 3.3, 95% CI: 2.1-5.1) than <2 year-olds (OR 0.9, 95% CI: 0.6-1.3) when compared to accidental head trauma cases.
Conclusions: There is a considerable risk of mortality associated with age of diagnosis for AHT. This suggests the need for improved vigilance and early diagnosis of older toddlers, a group of children often considered at low-risk for AHT.
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