Increased mortality in very young children with traumatic brain injury due to abuse: A nationwide analysis of 10,965 patients

Christina M. Theodorou, Miriam A Nuno, Kaeli J. Yamashiro, Erin G. Brown

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Traumatic brain injury (TBI) is the leading cause of death and disability in young children; however, the impact of mechanism on outcomes has not been fully evaluated. We hypothesized that children with TBI due to abuse would have a higher mortality than children with accidental TBI due to motor vehicle collisions (MVC). Methods: We performed a retrospective review of the National Kids’ Inpatient (KID) hospitalizations database of children <2 years old with TBI due to abuse or MVC (2000–2016). The primary outcome was mortality. Secondary outcomes were length of stay (LOS) and hospital charges. We investigated predictors of mortality with multivariable regression. Results: Of 10,965 children with TBI, 65.2% were due to abuse. Overall mortality was 9.8% (n = 1074). Abused children had longer LOS (5.7 vs 1.6 days, p < 0.0001) and higher hospital charges ($34,314 vs $19,360, p < 0.0001) than children with TBI due to MVC. The odds of mortality were 42% higher in children with abusive head trauma (OR 1.42, 95% CI 1.10–1.83, p = 0.007) compared to MVCs after adjusting for age, race, sex, neurosurgical intervention, injury severity, and insurance. Conclusion: Children with abusive traumatic brain injury have increased risk of mortality, longer LOS, and higher hospital charges compared to children with TBI due to motor vehicle collision after adjusting for relevant confounders. Resources must be directed at prevention and early identification of abuse.

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StateAccepted/In press - 2021

Keywords

  • Accidental head injury
  • Child abuse
  • Mortality
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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