Injury, child and family factors predict neurodevelopment outcomes after abusive head trauma

Abstract

Background: There is a lack of consensus on how best to measure injury severity in abusive head trauma in order to predict long-term neurodevelopmental outcomes.

Objective: We hypothesized that a constellation of injury-related variables along with child and family variables would more accurately predict outcomes in children who have sustained an AHT than the Glasgow Coma Scale (GCS) alone.

Participants and setting: In 2012-2020, we enrolled 270 patients (median age 4.6 months) treated for AHT at a large tertiary care children's hospital who survived their injuries and came to a multi-disciplinary follow-up clinic.

Methods: Exploratory analyses examined bivariate relationships of injury severity and child and family variables with neurodevelopmental outcomes, as measured by the Bayley Scales of Infant and Toddler Development, using Pearson correlations, independent samples t-tests, and one-way ANOVAs. These exploratory analyses informed the selection of variables for stepwise multivariate regressions predicting neurodevelopmental outcomes.

Results: Stepwise regression revealed that a constellation of injury-related variables including cytotoxic edema, length of intensive care stay, neurosurgical intervention, seizures, intubation, eye injuries, and abnormal spine imaging explained significantly more variance in Bayley scores than GCS alone (14-22 %, all p-values < .01). The largest effect sizes were for measures of hospital course (length of intensive care stay, neurosurgical intervention, seizures, and intubation). Including child and family variables explained an additional 6-10 % of the variance (all p-values < .05).

Conclusions: A constellation of injury-related variables, especially those related to hospital course, was more predictive of neurodevelopment than solely GCS for children with AHT.

Keywords: Child abuse; Neurodevelopmental outcomes; Nonaccidental; Shaken baby.