1
|
Sayrs LW, Ortiz JB, Notrica DM, Kirsch L, Kelly C, Stottlemyre R, Cohen A, Misra S, Green TR, Adelson PD, Lifshitz J, Rowe RK. Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP6785-NP6812. [PMID: 33092447 DOI: 10.1177/0886260520967151] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Over half of fatal pediatric traumatic brain injuries are estimated to be the result of physical abuse, i.e., abusive head trauma (AHT). Although intimate partner violence (IPV) is a well-established risk for child maltreatment, little is known about IPV as an associated risk factor specifically for AHT. We performed a single-institution, retrospective review of all patients (0-17 years) diagnosed at a Level 1 pediatric trauma center with head trauma who had been referred to an in-hospital child protection team for suspicion of AHT between 2010 and 2016. Data on patient demographics, hospitalization, injury, family characteristics, sociobehavioral characteristics, physical examination, laboratory findings, imaging, discharge, and forensic determination of AHT were extracted from the institution's forensic registry. Descriptive statistics (mean, median), chi-square and Mann-Whitney U tests were used to compare patients with fatal head injuries to patients with nonfatal head injuries by clinical characteristics, family characteristics, and forensic determination. Multiple logistic regression was used to estimate adjusted odds ratios for the presence of IPV as an associated risk of AHT while controlling for other clinical and family factors. Of 804 patients with suspicion for AHT in the forensic registry, there were 240 patients with a forensic determination of AHT; 42 injuries were fatal. There were 101 families with a reported history of IPV; 64.4% of patients in families with reported IPV were <12 months of age. IPV was associated with a twofold increase in the risk of AHT (Exp(β) = 2.3 [p = .02]). This study confirmed IPV was an associated risk factor for AHT in a single institution cohort of pediatric patients with both fatal and nonfatal injuries. Identifying IPV along with other family factors may improve detection and surveillance of AHT in medical settings and help reduce injury, disability, and death.
Collapse
Affiliation(s)
- Lois W Sayrs
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - J Bryce Ortiz
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - David M Notrica
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Lisa Kirsch
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Cara Kelly
- Phoenix Children's Hospital, Phoenix, AZ, USA
- Arizona State University School of Social Work, Phoenix, AZ, USA
| | | | - Aaron Cohen
- Valleywise Health Medical Center, Phoenix, AZ, USA
| | - Shivani Misra
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Tabitha R Green
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - P David Adelson
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Jonathan Lifshitz
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, USA
| | - Rachel K Rowe
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, USA
| |
Collapse
|
3
|
Ji J, Qian SY, Liu J, Gao HM. Occurrence of early epilepsy in children with traumatic brain injury: a retrospective study. World J Pediatr 2022; 18:214-221. [PMID: 35150398 DOI: 10.1007/s12519-021-00502-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Early post-traumatic seizures (EPTS) refer to epileptic seizures occurring within one week after brain injury. This study aimed to define the risk factors of EPTS and the protective factors that could prevent its occurrence. METHODS This is a single-center retrospective study in the PICU, Beijing Children's Hospital. Patients diagnosed with traumatic brain injury (TBI), admitted with and without EPTS between January 2016 and December 2020 were included in the study. RESULTS We included 108 patients diagnosed with TBI. The overall EPTS incidence was 33.98% (35/108). The correlation between EPTS and depressed fractures is positive (P = 0.023). Positive correlations between EPTS and intracranial hemorrhage and subarachnoid hemorrhage had been established (P = 0.011and P = 0.004, respectively). The detection rates of EPTS in the electroencephalogram (EEG) monitoring was 80.00%. There was a significant difference in the EEG monitoring rate between the two groups (P = 0.041). Forty-one (37.86%, 41/108) post-neurosurgical patients were treated with prophylactic antiepileptic drugs (AEDs), and eight (19.51%, 8/41) still had seizures. No statistical significance was noted between the two groups in terms of prophylactic AEDs use (P = 0.519). Logistic regression analysis revealed that open craniocerebral injury and fever on admission were risk factors for EPTS, whereas, surgical intervention and use of hypertonic saline were associated with not developing EPTS. CONCLUSIONS Breakthrough EPTS occurred after severe TBI in 33.98% of pediatric cases in our cohort. This is a higher seizure incidence than that reported previously. Patients with fever on admission and open craniocerebral injuries are more likely to develop EPTS.
Collapse
Affiliation(s)
- Jian Ji
- Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 45 Nanlishi Road, Beijing, 100045, China
| | - Su-Yun Qian
- Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 45 Nanlishi Road, Beijing, 100045, China.
| | - Jun Liu
- Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 45 Nanlishi Road, Beijing, 100045, China
| | - Heng-Miao Gao
- Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 45 Nanlishi Road, Beijing, 100045, China
| |
Collapse
|
4
|
Babl FE, Tavender E, Ballard DW, Borland ML, Oakley E, Cotterell E, Halkidis L, Goergen S, Davis GA, Perry D, Anderson V, Barlow KM, Barnett P, Bennetts S, Bhamjee R, Cole J, Craven J, Haskell L, Lawton B, Lithgow A, Mullen G, O'Brien S, Paproth M, Wilson CL, Ring J, Wilson A, Leo GS, Dalziel SR. Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children. Emerg Med Australas 2021; 33:214-231. [PMID: 33528896 DOI: 10.1111/1742-6723.13722] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Children frequently present with head injuries to acute care settings. Although international paediatric clinical practice guidelines for head injuries exist, they do not address all considerations related to triage, imaging, observation versus admission, transfer, discharge and follow-up of mild to moderate head injuries relevant to the Australian and New Zealand context. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) set out to develop an evidence-based, locally applicable, practical clinical guideline for the care of children with mild to moderate head injuries presenting to acute care settings. METHODS A multidisciplinary Guideline Working Group (GWG) developed 33 questions in three key areas - triage, imaging and discharge of children with mild to moderate head injuries presenting to acute care settings. We identified existing high-quality guidelines and from these guidelines recommendations were mapped to clinical questions. Updated literature searches were undertaken, and key new evidence identified. Recommendations were created through either adoption, adaptation or development of de novo recommendations. The guideline was revised after a period of public consultation. RESULTS The GWG developed 71 recommendations (evidence-informed = 35, consensus-based = 17, practice points = 19), relevant to the Australian and New Zealand setting. The guideline is presented as three documents: (i) a detailed Full Guideline summarising the evidence underlying each recommendation; (ii) a Guideline Summary; and (iii) a clinical Algorithm: Imaging and Observation Decision-making for Children with Head Injuries. CONCLUSIONS The PREDICT Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children provides high-level evidence and practical guidance for front line clinicians.
Collapse
Affiliation(s)
- Franz E Babl
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dustin W Ballard
- Clinical Research on Emergency Services and Treatment (CREST) Network and Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Cotterell
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Lambros Halkidis
- Emergency Department, Cairns Hospital, Cairns, Queensland, Australia
| | - Stacy Goergen
- Monash Health Imaging, Monash Health, Melbourne, Victoria, Australia.,Departments of Surgery and Medical Imaging, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurosurgery, Cabrini Hospital, Melbourne, Victoria, Australia
| | - David Perry
- Radiology Department, Starship Children's Hospital, Auckland, New Zealand
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Psychology Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Karen M Barlow
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Neurosciences Unit, Queensland Paediatric Rehabilitation Service, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Peter Barnett
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Scott Bennetts
- Clinical Effectiveness, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Roisin Bhamjee
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joanne Cole
- Emergency Department, Tauranga Hospital, Tauranga, New Zealand
| | - John Craven
- Emergency Department, Women and Children's Hospital, Adelaide, South Australia, Australia.,MedSTAR, SA Ambulance, Adelaide, South Australia, Australia.,Emergency Department, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Libby Haskell
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Ben Lawton
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Don't Forget the Bubbles, Sydney, New South Wales, Australia.,Emergency Department, Logan Hospital, Logan, Queensland, Australia
| | - Anna Lithgow
- Emergency Department, The Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Glenda Mullen
- Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Nursing, Curtin University, Perth, Western Australia, Australia
| | | | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jenny Ring
- Health Research Consulting, Sydney, New South Wales, Australia
| | - Agnes Wilson
- Health Research Consulting, Sydney, New South Wales, Australia
| | - Grace Sy Leo
- Don't Forget the Bubbles, Sydney, New South Wales, Australia.,Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | | |
Collapse
|