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Long-term outcome of abusive head trauma

  • Special Issue: Abusive Head Trauma
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Abusive head trauma is a severe inflicted traumatic brain injury, occurring under the age of 2 years, defined by an acute brain injury (mostly subdural or subarachnoidal haemorrhage), where no history or no compatible history with the clinical presentation is given. The mortality rate is estimated at 20-25% and outcome is extremely poor. High rates of impairments are reported in a number of domains, such as delayed psychomotor development; motor deficits (spastic hemiplegia or quadriplegia in 15–64%); epilepsy, often intractable (11–32%); microcephaly with corticosubcortical atrophy (61–100%); visual impairment (18–48%); language disorders (37–64%), and cognitive, behavioral and sleep disorders, including intellectual deficits, agitation, aggression, tantrums, attention deficits, memory, inhibition or initiation deficits (23–59%). Those combined deficits have obvious consequences on academic achievement, with high rates of special education in the long term. Factors associated with worse outcome include demographic factors (lower parental socioeconomic status), initial severe presentation (e.g., presence of a coma, seizures, extent of retinal hemorrhages, presence of an associated cranial fracture, extent of brain lesions, cerebral oedema and atrophy). Given the high risk of severe outcome, long-term comprehensive follow-up should be systematically performed to monitor development, detect any problem and implement timely adequate rehabilitation interventions, special education and/or support when necessary. Interventions should focus on children as well as families, providing help in dealing with the child’s impairment and support with psychosocial issues. Unfortunately, follow-up of children with abusive head trauma has repeatedly been reported to be challenging, with very high attrition rates.

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Authors and Affiliations

  1. Rehabilitation Department for Children with Acquired Neurological Injury – Saint Maurice Hospitals, 14, rue du Val d’Osne, 94410, Saint Maurice, France

    Mathilde P. Chevignard

  2. Sorbonne Universités, UPMC Univ Paris 06, UMR 7371, UMR_S 1146, LIB, Paris, France

    Mathilde P. Chevignard

  3. CNRS, UMR 7371, LIB, Paris, France

    Mathilde P. Chevignard

  4. INSERM, UMR_S 1146, LIB, Paris, France

    Mathilde P. Chevignard

  5. Necker Enfants Malades Hospital, 149 rue de Sèvres, Paris, France

    Katia Lind

  6. Paris Descartes University, Paris, France

    Katia Lind

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  1. Mathilde P. Chevignard
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  2. Katia Lind
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Correspondence to Mathilde P. Chevignard.

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Chevignard, M.P., Lind, K. Long-term outcome of abusive head trauma. Pediatr Radiol 44 (Suppl 4), 548–558 (2014). https://doi.org/10.1007/s00247-014-3169-8

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  • DOI: https://doi.org/10.1007/s00247-014-3169-8

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