Advertisement

Child's Nervous System

, Volume 28, Issue 6, pp 889–896 | Cite as

Early clinical indicators of developmental outcome in abusive head trauma

  • Mary V. GreinerEmail author
  • Alice P. Lawrence
  • Paul Horn
  • Amy J. Newmeyer
  • Kathi L. Makoroff
Original Paper

Abstract

Purpose

The purpose of the study was to determine the developmental prognostic significance of early clinical indicators in abusive head trauma.

Methods

Seventy-one children were diagnosed with abusive head trauma and followed in a post-injury growth and development clinic. A retrospective chart review was completed to gather clinical features at the time of injury, including presence or absence of early post-traumatic seizures, presence or absence of intubation, and presence or absence of pediatric intensive care unit admission. Children then underwent developmental testing with use of the Capute Scales of the Cognitive Adaptive Test (CAT) and the Clinical Linguistic and Auditory Milestone Scale (CLAMS) during follow-up clinic visits. Clinical features at initial injury were compared to developmental outcome.

Results

Thirty-four of 71 patients with seizures during their admission hospitalization scored significantly lower on follow-up developmental testing than patients who did not have seizures. Twenty-one of 71 patients who required intubation scored lower on developmental testing than patients who did not require intubation. Thirty-five of 71 patients who required pediatric intensive care unit admission scored lower on developmental testing than patients who did not require pediatric intensive care unit admission.

Conclusions

This study demonstrates that clinical factors at the time of injury, such as early post-traumatic seizures and intubation requirement, are associated with poorer developmental outcome. This study also suggests that close developmental follow-up should be obtained for all children with abusive head trauma, regardless of whether or not the child was admitted to the PICU.

Keywords

Abuse Developmental outcome Head trauma Intensive care Seizure 

References

  1. 1.
    Leventhal JM, Martin KD, Asnes AG (2010) Fractures and traumatic brain injuries: abuse versus accidents in a US database of hospitalized children. Pediatrics 126:e104–e115PubMedCrossRefGoogle Scholar
  2. 2.
    Kesler H, Dias MS, Shaffer M, Rottmund C, Cappos K, Thomas NJ (2008) Demographics of abusive head trauma in the Commonwealth of Pennsylvania. J Neurosurg Pediatr 1:351–356PubMedCrossRefGoogle Scholar
  3. 3.
    Overpeck MD, Brenner RA, Trumble AC, Trifiletti LB, Berendes HW (1998) Risk factors for infant homicide in the United States. N Engl J Med 339:1211–1216PubMedCrossRefGoogle Scholar
  4. 4.
    Barlow KM, Minns RA (2000) Annual incidence of shaken impact syndrome in young children. Lancet 356:1571–1572PubMedCrossRefGoogle Scholar
  5. 5.
    Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH (2003) A population-based study of inflicted traumatic brain injury in young children. JAMA 290:621–626PubMedCrossRefGoogle Scholar
  6. 6.
    Theodore AD, Chang JJ, Runyan DK, Hunter WM, Bangdiwala SI, Agans R (2005) Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas. Pediatrics 115:331–337CrossRefGoogle Scholar
  7. 7.
    Makaroff KL, Putnam FW (2003) Outcomes of infants and children with inflicted traumatic brain injury. Dev Med Child Neurol 45:497–502PubMedCrossRefGoogle Scholar
  8. 8.
    Adamo MA, Drazin D, Smith C, Waldman JB (2009) Comparison of accidental and nonaccidental traumatic brain injuries in infants and toddlers: demographics, neurosurgical interventions, and outcomes. J Neurosurg Pediatr 4:414–419PubMedCrossRefGoogle Scholar
  9. 9.
    Keenan HT, Runyan DK, Nocera M (2006) Child outcomes and family characteristics 1 year after severe inflicted or noninflicted traumatic brain injury. Pediatrics 117:317–324PubMedCrossRefGoogle Scholar
  10. 10.
    Keenan HT, Runyan DK, Nocera MA (2006) Child outcomes and family characteristics 1 year after severe inflicted or noninflicted traumatic brain injury. Pediatrics 117:317–324PubMedCrossRefGoogle Scholar
  11. 11.
    Barlow K, Thompson E, Johnson D, Minns RA (2004) The neurological outcome of non-accidental head injury. Pediatr Rehabil 7:195–203PubMedGoogle Scholar
  12. 12.
    Barlow K, Thompson E, Johnson D, Minns RA (2005) Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy. Pediatrics 116:174–185CrossRefGoogle Scholar
  13. 13.
    Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF (2004) A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics 114:633–639PubMedCrossRefGoogle Scholar
  14. 14.
    Fortune PM, Shann F (2010) The motor response to stimulation predicts outcome as well as the full Glasgow Coma Scale in children with severe head injury. Pediatr Crit Care Med 11:339–342PubMedGoogle Scholar
  15. 15.
    Calvert S, Miller HE, Curran A, Hameed B, McCarter R, Edwards RJ, Hunt L, Sharples PM (2008) The King’s Outcome Scale for Childhood Head Injury and injury severity and outcome measures in children with traumatic brain injury. Dev Med Child Neurol 50:426–431PubMedCrossRefGoogle Scholar
  16. 16.
    Capute AJ, Accardo PJ (1996) The infant neurodevelopmental assessment: a clinical interpretive manual for CAT–CLAMS in the first two years of life, Part 2. Curr Probl Pediatr 26:279–306PubMedGoogle Scholar
  17. 17.
    Capute AJ, Accardo PJ (1996) The infant neurodevelopmental assessment: a clinical interpretive manual for CAT–CLAMS in the first two years of life, part 1. Curr Probl Pediatr 26:238–257PubMedCrossRefGoogle Scholar
  18. 18.
    Chang YC, Huang CC, Hu SC (1998) Establishing the norm of Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) in Chinese infants. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 39:306–313PubMedGoogle Scholar
  19. 19.
    Hoon Jr AH, Pulsifer MB, Gopalan R, Palmer FB, Capute AJ (1993) Clinical adaptive test/clinical linguistic auditory milestone scale in early cognitive assessment. Journal of Pediatrics 123Google Scholar
  20. 20.
    Kube DA, Wilson WM, Petersen MC, Palmer FB (2000) CAT/CLAMS: its use in detecting early childhood cognitive impairment. Pediatr Neurol 23:208–215PubMedCrossRefGoogle Scholar
  21. 21.
    Macias MM, Saylor CF, Greer MK, Charles JM, Bell N, Katikaneni LD (1998) Infant screening: the usefulness of the Bayley Infant Neurodevelopmental Screener and the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale. J Dev Behav Pediatr 19:155–161PubMedCrossRefGoogle Scholar
  22. 22.
    Pittock ST, Juhn YJ, Adegbenro A, Voigt RG (2002) Ease of administration of the cognitive adaptive test/clinical linguistic and auditory milestone scale (CAT/CLAMS) during pediatric well-child visits. Clin Pediatr (Phila) 41:397–403CrossRefGoogle Scholar
  23. 23.
    Rossman MJ, Hyman SL, Rorabaugh ML, Berlin LE, Allen MC, Modlin JF (1994) The CAT/CLAMS assessment for early intervention services. Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale. Clin Pediatr (Phila) 33:404–409CrossRefGoogle Scholar
  24. 24.
    Vanprapar N, Kongstan N, Tritilanant P, Kottapat U, Durier Y, Tritilanant S (2005) Developmental screening by the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) in HIV-infected children. J Med Assoc Thai 88(Suppl 8):S211–S214PubMedGoogle Scholar
  25. 25.
    Voigt RG, Brown FR 3rd, Fraley JK, Llorente AM, Rozelle J, Turcich M, Jensen CL, Heird WC (2003) Concurrent and predictive validity of the cognitive adaptive test/clinical linguistic and auditory milestone scale (CAT/CLAMS) and the Mental Developmental Index of the Bayley Scales of Infant Development. Clin Pediatr (Phila) 42:427–432CrossRefGoogle Scholar
  26. 26.
    Wachtel RC, Shapiro BK, Palmer FB, Allen MC, Capute AJ (1994) CAT/CLAMS. A tool for the pediatric evaluation of infants and young children with developmental delay. Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale. Clin Pediatr (Phila) 33:410–415CrossRefGoogle Scholar
  27. 27.
    Wang LW, Wang ST, Huang CC (2005) Validity of the Clinical Adaptive Test (CAT)/Clinical Linguistic and Auditory Milestone Scale (CLAMS) as a screening instrument for very low birth weight infants in Taiwan. J Dev Behav Pediatr 26:412–418PubMedCrossRefGoogle Scholar
  28. 28.
    Visintainer PF, Leppert M, Bennett A, Accardo PJ (2004) Standardization of the Capute Scales: methods and results. J Child Neurol 19:967–972PubMedGoogle Scholar
  29. 29.
    Wickremasinghe AC, Hartman TK, Voigt RG, Katusic SK, Weaver AL, Colby CE, Barbaresi WJ (2011) Evaluation of the ability of neurobiological, neurodevelopmental and socio-economic variables to predict cognitive outcome in premature infants. Child Care Health DevGoogle Scholar
  30. 30.
    Myers SE, Whitman BY, Carrel AL, Moerchen V, Bekx MT, Allen DB (2007) Two years of growth hormone therapy in young children with Prader–Willi syndrome: physical and neurodevelopmental benefits. Am J Med Genet A 143:443–448PubMedGoogle Scholar
  31. 31.
    Vincer MJ, Cake H, Graven M, Dodds L, McHugh S, Fraboni T (2005) A population-based study to determine the performance of the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale to predict the mental developmental index at 18 months on the Bayley Scales of Infant Development-II in very preterm infants. Pediatrics 116:e864–e867PubMedCrossRefGoogle Scholar
  32. 32.
    Accardo PJ, Capute AJ (2008) Capute & Accardo’s neurodevelopmental disabilities in infancy and childhood. Brookes, BaltimoreGoogle Scholar
  33. 33.
    Marion DW, Carlier PM (1994) Problems with initial Glasgow Coma Scale assessment caused by prehospital treatment of patients with head injuries: results of a national survey. J Trauma 36:89–95PubMedCrossRefGoogle Scholar
  34. 34.
    Buechler CM, Blostein PA, Koestner A, Hurt K, Schaars M, McKernan J (1998) Variation among trauma centers’ calculation of Glasgow Coma Scale score: results of a national survey. J Trauma 45:429–432PubMedCrossRefGoogle Scholar
  35. 35.
    Lieh-Lai MW, Theodorou AA, Sarnaik AP, Meert KL, Moylan PM, Canady AI (1992) Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury. J Pediatr 120:195–199PubMedCrossRefGoogle Scholar
  36. 36.
    Anderson SI, Housley AM, Jones PA, Slattery J, Miller JD (1993) Glasgow Outcome Scale: an inter-rater reliability study. Brain Inj 7:309–317PubMedCrossRefGoogle Scholar
  37. 37.
    Anderson V, Jacobs R, Spencer-Smith M, Coleman L, Anderson P, Williams J, Greenham M, Leventer R (2010) Does early age at brain insult predict worse outcome? Neuropsychological implications. J Pediatr Psychol 35:716–727PubMedCrossRefGoogle Scholar
  38. 38.
    Anderson V, Spencer-Smith M, Leventer R, Coleman L, Anderson P, Williams J, Greenham M, Jacobs R (2009) Childhood brain insult: can age at insult help us predict outcome? Brain 132:45–56PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Mary V. Greiner
    • 1
    Email author
  • Alice P. Lawrence
    • 2
  • Paul Horn
    • 1
  • Amy J. Newmeyer
    • 3
  • Kathi L. Makoroff
    • 1
  1. 1.Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of PediatricsChildren’s Hospital of VanderbiltNashvilleUSA
  3. 3.Department of PediatricsChildren’s Hospital of the King’s DaughterNorfolkUSA

Personalised recommendations