Associated Risk of Head Trauma in Child Maltreatment

Abstract

Background- Almost 70% of infant deaths are associated with head trauma, making traumatic brain injury a leading cause of death and disability in infants. Those who survive have lifelong physical, developmental, and emotional sequelae. As such, efforts to characterize and understand the factors that lead to head trauma in infants is critical. Methods- This was a single-institution, retrospective review of suspected AHT patients from 2010-2017. Data were collected on demographics, hospitalization, injury, family characteristics, socio-behavioral characteristics, physical examination, laboratory findings, imaging, discharge, and other follow-up information on fatal and non-fatal head trauma. Statistical analysis involved descriptive statistics, logistic regression, and receiver operating characteristics. Results- Key risks associated with AHT included bruising (OR: 6.1; 95%CI: 3.5-10.5), multiple fractures (OR: 9.5; 95%CI: 4.2-21.5), unknown method of injury (OR: 3.9; 95%CI: 2.2-7.0), self-reported history of substance abuse (OR: 8.8; 95%CI: 3.0-26.0), prior Child Protective Services reports (OR: 2.1; 95%CI: 1.1-3.9), prior police involvement (OR: 5.3; 95%CI: 2.7- 10.4), domestic violence (OR: 1.3; 95%CI: 1.3-5.5), and unknown number of adults in the home (OR: 4.2; 95%CI: 2.4-7.4). The regression model captured 57% of the variance, was 73% sensitive, and was 90% specific using ROC. Conclusions- We propose to broaden the classification of AHT to include inflicted injury and non-inflicted injury, along with a new category called “traumatic injury from an unexplained Event.” An expanded classification system for AHT would capture abuse, neglect, and undetermined patients, making AHT more useful in surveillance, screening, treatment, and prevention of head injury in very young children.