Understanding the factors that contribute to abusive head trauma in kids


Abusive head trauma often requires immediate action upon presentation. An investigation probes the factors that may lead to higher mortality.

Understanding the features and factors of high mortality as a result of abusive head trauma is incredibly important because of the severity of the diagnosis, which often requires prompt action. An investigation examines the demographic and clinical elements that are tied to higher mortality in abusive head trauma.1

The investigators ran a retrospective cross-sectional study that used the Nationwide Emergency Department Sample database to find all emergency department visits in the United States with a primary diagnosis of abusive head trauma in children aged younger than 5 years. The span of time for visits was January 2006 to December 2018. They were looking at prevalence, demographic characteristics, clinical characteristics, mortality, and economic burden that was tied to abusive head trauma.

They found an estimated 12, 287 cases with a primary diagnosis of abusive head trauma resulting in an emergency department visit for children aged younger than 5 years. Estimated cases went down by 675 from 2006 to 2018 (95% CI, 403-940; P < .001), with the incidence decreasing by 6.7% every year (incidence rate ratio, 0.93; 95% CI, 0.93-0.94; P < .001). Six hundred and forty-six patients died during a hospital visit. Investigators found that the majority of patients with abusive head trauma were male (59.2%), used Medicaid (70.0%), and were aged younger than 1 year (57.3%). Following controlling for demographic characteristics, the investigators found the following factors were tied to increased mortality:

  • age greater than 1 year (odds ratio [OR], 2.45; 95% CI, 1.50-3.99; P < .001),
  • first or second income quartile (OR, 1.78; 95% CI, 1.08-2.91; P = .02),
  • midwestern United States (OR, 2.04; 95% CI, 1.04-4.00; P = .04),
  • level 1 trauma center (OR, 2.69; 95% CI, 1.07-6.75; P = .04),
  • orbital fracture (OR, 15.38; 95% CI, 2.41-98.18; P = .004),
  • cerebral edema (OR, 8.49; 95% CI, 5.57-12.93; P < .001),
  • intracranial hemorrhage (OR, 4.27; 95% CI, 1.71-10.67; P = .002),
  • hypoxic ischemic brain injury (OR, 4.16; 95% CI, 2.13-8.10; P < .001),
  • skull fractures (OR, 3.20; 95% CI, 1.76-5.82; P < .001),
  • subarachnoid hemorrhage (OR, 2.43; 95% CI, 1.22-4.83; P = .01),
  • retinal hemorrhage (OR, 2.17; 95% CI, 1.40-3.38; P < .001), and
  • subdural hemorrhage (OR, 2.05; 95% CI, 1.05-3.98; P = .04).

The investigators concluded that disparities may occur in the treatment of abusive head trauma. The findings indicate that public health care agencies should consider particularly focusing on areas that are low income as well as areas in the Midwest.


  1. Shah Y, Iftikhar M, Justin G, Canner J, Woreta F. A national analysis of ophthalmic features and mortality in abusive head trauma. JAMA Ophthalmol. January 20, 2022. Epub ahead of print. doi:10.1001/jamaophthalmol.2021.5907
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