Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. 1608-1609 (doi:10.1542/peds.2005-2096)
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Initial Neurologic Presentation in Young Children Sustaining Inflicted and Unintentional Fatal Head Injuries: In Reply

Kristy B. Arbogast, PhD
Susan S. Margulies, PhD
Cindy W. Christian, MD
University of Pennsylvania,
Children's Hospital of Philadelphia,
Philadelphia, PA 19104

In Reply.—

We thank Drs Byard and Donald for highlighting the limitations associated with large retrospective data sets in reference to our article. The purpose of our analyses in this article was to report the range of clinical presentations of infants and toddlers who die as a result of intentional and unintentional brain trauma. We used a large data set of young children with fatal brain injuries to overcome the limitations of previous studies of small sample size. We agree with Byard and Donald's concern regarding the limitations of retrospective data of this kind. For this reason, we were careful in the discussion of the article to highlight these limitations. Specifically, we stated in our concluding paragraph: "Whether [our results are] because of differences in pathologic injury, neurologic responses unique to the infant brain, or limitations of the bedside methods used to assess neurologic function in young children cannot be determined by this study." We are pleased that Byard and Donald agree with our recommendation that a prospective study is both urgent and ideal. Last, Byard and Donald reiterate a concern that we noted in our discussion about the potential for misclassification of injury-mechanism type in the patients. For that reason, the emphasis of statistical evaluation in this article was restricted to comparisons between motor vehicle crashes and intentional injury, which are less likely to be misclassified than deaths resulting from falls. However, it is important to note that the data related to injury mechanism and age (shown in our Fig 1) meet our clinical expectations. For example, intentional injury was greatest in those <12 months old, falls peaked between 12 and 24 months, and motor vehicle crashes increased with age. Thus, although we cannot guarantee that all children were classified correctly, it is unlikely that falls in infants have been overreported, which was the concern raised by Byard and Donald, because very few infant deaths were attributed to falls in this data set. In summary, we agree with Byard and Donald's recommendations for future research and look forward to reviewing data from properly designed and controlled prospective studies. Until such data are available, our analysis of retrospective data provides valuable insight regarding the complex spectrum of presentation of young children who die as a result of fatal brain trauma.

PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

Related articles in Pediatrics:

Initial Neurologic Presentation in Young Children Sustaining Inflicted and Unintentional Fatal Head Injuries
Roger W. Byard and Terence G. Donald
Pediatrics 2005 116: 1608. [Extract] [Full Text]  




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