Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study.

Background: Abusive head trauma (AHT) is associated with high morbidity and mortality. It may be difficult to detect in the emergency department (ED). Objective(s): To determine how cases of suspected AHT differ from non-abusive head injuries in the ED setting. Method(s): Planned secondary analysis of prospective multicentre cohort study of children aged <18 years across 10 centres in Australia and New Zealand with head injuries. We identified cases of suspected AHT when ED clinicians identified such suspicion on a clinical report form or based on research assistant assigned epidemiology codes. We compared suspected AHT cases and non-AHT cases using risk ratios with 95% confidence intervals (CIs). We assessed the rate of clinically important traumatic brain injuries [ciTBI: death; neurosurgery; intubation >1 day, admission >2 days with abnormal computed tomography (CT) scan]. Result(s): AHT was suspected in 103 of 20 137 (0.5%) headinjured children. Mean age was 2.4 years (SD 4.0). GCS was <12 in 9 (8.7%). 12 (11.7%) presented with seizures. 71 (68.9%) underwent CT head scan, of which 49 (69.0%) were abnormal. 80 (77.7%) children were admitted. Neurosurgery was performed in 3, and 2 children died. 23 (22.3%) had ciTBI. RRs (95% CI) for AHT vs. non AHT were: LOC 1.4 (0.7-2.7), vomiting 1.6 (1.2-2.2), scalp haematoma 2.3 (2.0-2.6), GCS <12 8.5 (4.5-16.0), abnormal neuroimaging 16.4 (13.2-20.4), neurosurgery 7.4 (2.4-22.9), mortality 29.9 (6.8-130.9) and ciTBI 17.4 (6.8-25.5). Conclusion(s): In the ED, clinical presentation in children with suspected AHT differs from non-AHT cases. Suspected cases of AHT are at increased risk of abnormal CT scans, ciTBI and death.