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Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country

Background: Abusive head trauma (AHT) is a severe manifestation of physical abuse in young children. This study examines the outcome of AHT in children under 2 years and features associated with mortality and disability. Methods: Retrospective chart review of 72 children under 2 years diagnosed to h...

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Main Authors: Ang, Siew-Chen, Marret, Mary J., Jayanath, Subhashini, Khoo, Wee-Vien, Takwir, Muhammad Fawwaz-Qisti Mohd
Format: Article
Published: Pergamon-Elsevier Science Ltd 2021
Subjects:
BF Psychology
Online Access:http://eprints.um.edu.my/28020/
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spelling my.um.eprints.280202022-06-13T07:46:28Z http://eprints.um.edu.my/28020/ Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country Ang, Siew-Chen Marret, Mary J. Jayanath, Subhashini Khoo, Wee-Vien Takwir, Muhammad Fawwaz-Qisti Mohd BF Psychology Background: Abusive head trauma (AHT) is a severe manifestation of physical abuse in young children. This study examines the outcome of AHT in children under 2 years and features associated with mortality and disability. Methods: Retrospective chart review of 72 children under 2 years diagnosed to have AHT between 2011 and 2018 at a tertiary teaching hospital in Malaysia. Demographic variables, clinical features, results of neuroimaging and their associations with outcome were explored. Results: The median age at presentation was 4 months, 78% were six months or younger and 68% were male. Two-thirds became unwell in the care of an alternative caregiver. Subdural hemorrhage was present in 98%. Mortality was 10%. Forty-nine survivors returned with median interval of 16 months (IQR 5-44 months) between discharge and last follow-up. At least 35% of 65 survivors were disabled with 29% having multiple disabilities. Multiple disabilities (61.1% versus 25.8%) and cognitive impairment (61.1% versus 22.6%) were significantly higher in children 3 years or older at last follow-up (p < 0.05). Signs of brainstem dysfunction at presentation, requirement for ventilation and hypoxic-ischemic injury on neuroimaging were associated with mortality. Needing ventilation, cerebral edema and neurological or visual impairment at discharge were associated with disability. Conclusions: Outcomes of death or disability in 42% make prevention of AHT a public health priority. Survivors require long-term multi-disciplinary follow-up for coordination of rehabilitation and educational support. Prevention should be directed at improving resources and services to support families in the care of young infants under 6 months. Pergamon-Elsevier Science Ltd 2021-10 Article PeerReviewed Ang, Siew-Chen and Marret, Mary J. and Jayanath, Subhashini and Khoo, Wee-Vien and Takwir, Muhammad Fawwaz-Qisti Mohd (2021) Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country. Child Abuse & Neglect, 120. ISSN 0145-2134, DOI https://doi.org/10.1016/j.chiabu.2021.105187 <https://doi.org/10.1016/j.chiabu.2021.105187>. 10.1016/j.chiabu.2021.105187
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic BF Psychology
spellingShingle BF Psychology
Ang, Siew-Chen
Marret, Mary J.
Jayanath, Subhashini
Khoo, Wee-Vien
Takwir, Muhammad Fawwaz-Qisti Mohd
Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country
description Background: Abusive head trauma (AHT) is a severe manifestation of physical abuse in young children. This study examines the outcome of AHT in children under 2 years and features associated with mortality and disability. Methods: Retrospective chart review of 72 children under 2 years diagnosed to have AHT between 2011 and 2018 at a tertiary teaching hospital in Malaysia. Demographic variables, clinical features, results of neuroimaging and their associations with outcome were explored. Results: The median age at presentation was 4 months, 78% were six months or younger and 68% were male. Two-thirds became unwell in the care of an alternative caregiver. Subdural hemorrhage was present in 98%. Mortality was 10%. Forty-nine survivors returned with median interval of 16 months (IQR 5-44 months) between discharge and last follow-up. At least 35% of 65 survivors were disabled with 29% having multiple disabilities. Multiple disabilities (61.1% versus 25.8%) and cognitive impairment (61.1% versus 22.6%) were significantly higher in children 3 years or older at last follow-up (p < 0.05). Signs of brainstem dysfunction at presentation, requirement for ventilation and hypoxic-ischemic injury on neuroimaging were associated with mortality. Needing ventilation, cerebral edema and neurological or visual impairment at discharge were associated with disability. Conclusions: Outcomes of death or disability in 42% make prevention of AHT a public health priority. Survivors require long-term multi-disciplinary follow-up for coordination of rehabilitation and educational support. Prevention should be directed at improving resources and services to support families in the care of young infants under 6 months.
format Article
author Ang, Siew-Chen
Marret, Mary J.
Jayanath, Subhashini
Khoo, Wee-Vien
Takwir, Muhammad Fawwaz-Qisti Mohd
author_facet Ang, Siew-Chen
Marret, Mary J.
Jayanath, Subhashini
Khoo, Wee-Vien
Takwir, Muhammad Fawwaz-Qisti Mohd
author_sort Ang, Siew-Chen
title Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country
title_short Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country
title_full Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country
title_fullStr Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country
title_full_unstemmed Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country
title_sort outcome of abusive head trauma in children less than 2 years: a single center study from a middle-income country
publisher Pergamon-Elsevier Science Ltd
publishDate 2021
url http://eprints.um.edu.my/28020/
_version_ 1735570297380143104
score 13.211869

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