Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 922-929 (doi:10.1542/peds.2006-3111)

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ARTICLE

Mechanisms, Clinical Presentations, Injuries, and Outcomes From Inflicted Versus Noninflicted Head Trauma During Infancy: Results of a Prospective, Multicentered, Comparative Study

Kent P. Hymel, MD^a,b, Kathi L. Makoroff, MD^c, Antoinette L. Laskey, MD, MPH^d, Mark R. Conaway, PhD^e and James A. Blackman, MD, MPH^a

^a Department of Pediatrics
^e Division of Biostatistics and Epidemiology, University of Virginia, Charlottesville, Virginia
^b Inova Fairfax Hospital for Children, Falls Church, Virginia
^c Department of Pediatrics, University of Cincinnati College of Medicine, Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
^d Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana

OBJECTIVE. Our goal was to conduct a prospective, multicentered, comparative study that would objectively verify and explain observed differences in short-term neurodevelopmental outcomes after inflicted versus noninflicted head trauma.

METHODS. Children <36 months of age who were hospitalized with acute head trauma confirmed by computed tomography imaging were recruited at multiple sites. Extensive clinical data were captured prospectively, subjects were examined, cranial imaging studies were blindly reviewed, and caregivers underwent scripted interviews. Follow-up neurodevelopmental evaluations were completed 6 months after injury. Head-trauma etiology and mechanisms were categorized by using objective a priori criteria. Thereafter, subject groups with inflicted versus noninflicted etiologies were compared.

RESULTS. Fifty-four subjects who met the eligibility criteria were enrolled at 9 sites. Of 52 surviving subjects, 27 underwent follow-up assessment 6 months after injury. Etiology was categorized as noninflicted in 30 subjects, inflicted in 11, and undetermined in 13. Compared with subjects with noninflicted head trauma, subjects with inflicted head trauma (1) more frequently experienced noncontact injury mechanisms, (2) sustained greater injury depth, (3) more frequently manifested acute cardiorespiratory compromise, (4) had lower initial Glasgow Coma Scale scores, (5) experienced more frequent and prolonged impairments of consciousness, (6) more frequently demonstrated bilateral, hypoxic-ischemic brain injury, (7) had lower mental developmental index scores 6 months postinjury, and (8) had lower gross motor quotient scores 6 months postinjury.

CONCLUSIONS. Compared with infants with noninflicted head trauma, young victims of inflicted head trauma experience more frequent noncontact injury mechanisms that result in deeper brain injuries, cardiorespiratory compromise, diffuse cerebral hypoxia-ischemia, and worse outcomes.

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Key Words: head trauma • infants • child abuse • accidents • outcomes

Abbreviations: GCS—Glasgow Coma Scale • PediBIRN—Pediatric Brain Injury Research Network • CT—computed tomography • MDI—mental developmental index • GMQ—gross motor quotient • MVC—motor vehicle crash • SDH—subdural hematoma

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Accepted Jan 16, 2007.

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