342 - Demographic and Clinical Factors Associated with Fatal Outcomes in Abusive Head Trauma: A Multicenter Study

Publication Number: 342.4422

Logan Bradshaw, Nationwide Children's Hospital, Oxford, MS, United States; Saroj Bista, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States; Stuart W. Sommers, Boston University School of Medicine, Boston, MA, United States; Daniel Lindberg, University of Colorado Anschutz Medical Campus, Denver, CO, United States; Nichole L. Michaels, Nationwide Children's Hospital, Columbus, OH, United States; Megan M.. Letson, Nationwide Children's Hospital, Columbus, OH, United States; Angela Bachim, Baylor College of Medicine, Houston, TX, United States; Kristine A. Campbell, University of Utah School of Medicine, Salt Lake City, UT, United States; Lori Frasier, Penn state hershey, Hershey, PA, United States; Nancy S. Harper, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Lyndsey Hultman, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Natalie Laub, University of California, San Diego School of Medicine, San Diego, CA, United States; Joanne N. Wood, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Farah Brink, Nationwide Children's Hospital, Columbus, OH, United States

Background: Abusive head trauma (AHT) is a leading cause of severe traumatic brain injury in infants and young children, with reported mortality rates of 5-35%. Knowledge of factors contributing to fatal outcomes in AHT is limited.

Objective: To identify demographic and clinical characteristics associated with fatal AHT.

Design/Methods: We included children < 10 years diagnosed with AHT undergoing evaluations by child abuse practitioners (CAPs) for physical abuse between 2/1/2021-9/30/2023 across 10 CAPNET sites. We defined AHT as any encounter identifying intracranial injuries including intracranial hemorrhage, parenchymal contusions/lacerations, hypoxic ischemic injury, axonal injury, and torn bridging veins with a CAP determination of abuse. Children with isolated findings of benign enlargement of subarachnoid space, skull fracture, subgaleal, or cephalohematoma were excluded. Demographic and clinical characteristics were compared between fatal and nonfatal AHT cases, using a chi-square, Fisher’s exact, or Wilcoxon-Mann Whitney test with P-values of < 0.05 indicating statistical significance. A multivariable logistic regression model constructed a priori, based on existing literature examined the association between patient and injury characteristics and fatal outcomes.

Results: Of 10,180 encounters in CAPNET, 2175 (21.4%) cases were identified with intracranial injuries. Of those, 617 (28.4%) encounters were diagnosed with AHT across 614 unique patients, of which 53 (8.6%) were fatal. Among fatalities, 62.3% were male and 71.7% had public insurance. Compared to non-fatal cases, fatalities were significantly older (median 5.6 mos, range 0.1-69.1 mos vs. median 4.0 mos, range 0.2-116.9 mos). A significantly greater proportion of fatal cases were diagnosed with axial fractures (54.7% vs 42.6%), abdominal/visceral/chest injuries (15.1% vs. 3.4%) or retinal hemorrhages (75.5% vs 49.3%), compared to non-fatal cases. Interhemispheric hemorrhage and midline shift/herniation were associated with increased risk of fatality. Our multivariable model showed abdominal/visceral/chest injuries (aOR: 4.59, 95% CI: 1.33 - 15.87), hypoxic-ischemic injury/edema (aOR 7.32, 95% CI: 3.18-16.85), midline shift or herniation (aOR: 3.55, 95% CI:1.67-7.56); and retinal hemorrhages (aOR: 3.79, 95% CI: 1.54-9.33) were associated with an increased risk of fatal outcomes.

Conclusion(s): This study underscores the significant mortality risk associated with AHT in young children and highlights the critical role of specific injuries increasing fatality risk.