Annual incidence of shaken impact syndrome in young children

doi:10.1016/S0140-6736(00)03130-5

The Lancet

Volume 356, Issue 9241, 4 November 2000, Pages 1571-1572

https://doi.org/10.1016/S0140-6736(00)03130-5 Get rights and content

Summary

We looked at the incidence and demography of non-accidental head injury in children in a prospective population-based study of paediatric units in Scotland during 1998–99. Shaken impact syndrome occurs with an annual incidence of 24·6 per 100 000 children younger than 1 year (95% CI 14·9-38·5). Cases are more common in urban regions, and during autumn and winter months. The risk of a child suffering non-accidental head injury by age 1 year is one in 4065. These brain injuries occur almost exclusively in young infants (median age 2·2 months).

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There are more references available in the full text version of this article.

Cited by (314)

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Long-Term Functional Outcome Following Neurosurgical Intervention for Suspected Abusive Head Trauma
2023, Pediatric Neurology
The purpose of this study was to evaluate the long-term functional and neurodevelopmental outcomes in pediatric patients who underwent neurosurgical intervention following suspected abusive head trauma (AHT).
We performed a single-center retrospective review (January 1, 2007, to December 31, 2019) of patients aged less than three years who had intracranial injury suspicious for AHT and received a neurosurgical procedure. Long-term functional outcome was measured using the Pediatric Cerebral Performance Category (PCPC), Pediatric Overall Performance Category (POPC), and the Mullen Scales of Early Learning (MSEL).
Seventy-seven patients were identified; 53 survived to discharge and had at least one-year follow-up. To examine long-term functional outcome, PCPC at the last available visit was examined and found to be 1 or 2 (normal to mild disability) for 64% of patients and 3 or 4 (moderate to severe disability) for 36%. The last available MSEL composite score for neurodevelopmental assessment also demonstrated that 13% of patients scored in the “average” range, 17% in the “below average” range, and 70% in the “very low” range. There was no statistical difference in the last available PCPC or POPC score or the last available MSEL score for patients who received a craniotomy when compared with those who received an intracranial shunt.
For patients with AHT who survived to discharge, functional improvements over time were noted in both patients who received craniotomy or who simply required shunt placement. These results suggest that, for patients who survive to discharge, operative management of AHT can lead to reasonable long-term functional outcomes.
Comparisons of characteristics and outcome between abusive head trauma and non-abusive head trauma in a pediatric intensive care unit
2023, Journal of the Formosan Medical Association
Abusive head trauma (AHT) is the leading cause of death in infants with traumatic brain injury (TBI). Early recognition of AHT is important for improving outcomes, but it can be challenging due to its similar presentations with non-abusive head trauma (nAHT). This study aims to compare clinical presentations and outcomes between infants with AHT and nAHT, and to identify the risk factors for poor outcomes of AHT.
We retrospectively analyzed infants of TBI in our pediatric intensive care unit from January 2014 to December 2020. Clinical manifestations and outcomes were compared between patients with AHT and nAHT. Risk factors for poor outcomes in AHT patients were also analyzed.
60 patients were enrolled for this analysis, including 18 of AHT (30%) and 42 of nAHT (70%). Compared with those with nAHT, patients with AHT were more likely to have conscious change, seizures, limb weakness, and respiratory failure, but with a fewer incidence of skull fractures. Additionally, clinical outcomes of AHT patients were worse, with more cases undergoing neurosurgery, higher Pediatric Overall Performance Category score at discharge, and more anti-epileptic drug (AED) use after discharge. For AHT patients, conscious change is an independent risk factor for a composite poor outcome of mortality, ventilator dependence, or AED use (OR = 21.9, P = 0.04)
AHT has a worse outcome than nAHT. Conscious change, seizures and limb weaknesses but not skull fractures are more common in AHT. Conscious change is both an early reminder of AHT and a risk factor for its poor outcomes.
Comparative study of brain damage and oxidative stress using two animal models of the shaken baby syndrome
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The objective was compare the morphological damages in brain and to evaluate the participation of oxidative stress, using two animal models of shaken baby syndrome (SBS). Five-day-old Wistar rats were used to develop two models of SBS as follows: Gyrotwister (GT) group was subjected to low intensity, high duration rotating movements and Ratshaker (RS) group made to undergo high intensity, low duration anteroposterior movements. Both groups presented respiratory distress, weight loss and shorter stature compared with the control group. In addition, involuntary movements occurred in both experimental models. Hemorrhage was observed in 10 % of the GT group and in 40 % of the RS group. This last group experienced lesser weight gain at 30 days. Glutathione decreased by 25.7 % (GT) and 59.96 (RT). Cell data analysis revealed the presence of crenate and pyknotic cells, characterized by apparent absence of nucleus and nucleolus as well as vacuolation in the GT group. In the RS group, there were a high number of angular, pyknotic and shrunken cells, and a lot of vacuolization. The severity of the brain damage can be related to the magnitude of biochemical modifications, specifically, those related to the production of reactive oxygen or nitrogen species, oxidative stress, oxidative damage.
Child maltreatment-related children's emergency department visits before and during the COVID-19 pandemic in Connecticut
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Citation Excerpt :
For example, the 2008 US economic recession and Hurricane Floyd highlighted the negative impact of societal disruption on rates of child maltreatment (Keenan, Marshall, Nocera, & Runyan, 2004a; Schneider, Waldfogel, & Brooks-Gunn, 2017; Wood et al., 2016). Specifically, the incidence of abusive head trauma, the most fatal form of child physical abuse, was shown to increase under these tumultuous circumstances (Barlow & Minns, 2000; Ellingson, Leventhal, & Weiss, 2008; Keenan, Runyan, Marshall, Nocera, & Merten, 2004b). These historical lessons emphasize the risk of child maltreatment during periods of societal destabilization, such as the Coronavirus Disease-2019 (COVID-19) pandemic.
Previous studies of national emergency department (ED) data demonstrate a decrease in visits coded for physical abuse during the pandemic period. However, no study to date has examined the incidence of multiple child maltreatment types (physical abuse, sexual abuse, and neglect), within a single state while considering state-specific closure policies. Furthermore, no similar study has utilized detailed chart review to identify cases, nor compared hospital data to Child Protective Services (CPS) reports.
To determine the incidence of child maltreatment-related ED visits before and during the COVID-19 pandemic, including characterizing the type of maltreatment, severity, and CPS reporting.
Children younger than 18 years old at two tertiary-care, academic children's hospitals in X state.
Maltreatment-related ED visits were identified by ICD-10-CM codes and keywords in chief concerns and provider notes. We conducted a cross-sectional retrospective review of ED visits and child abuse consultations during the pre-COVID (1/1/2019–3/15/2020) and COVID (3/16/2020–8/31/2020) periods, as well as state-level CPS reports for suspected maltreatment.
Maltreatment-related ED visits decreased from 15.7/week in the matched pre-COVID period (n = 380 total) to 12.3/week (n = 296 total) in the COVID period (P < .01). However, ED visits (P < .05) and CPS reports (P < .001) for child neglect increased during this period. Provider notes identified 62.4% of child maltreatment ED visits, while ICD-10 codes identified only-CM captured 46.8%.
ED visits for physical and sexual abuse declined, but neglect cases increased during the COVID-19 pandemic in X state.
Long-term impact of abusive head trauma in young children: Outcomes at 5 and 11 years old
2021, Journal of Pediatric Surgery
: Abusive head trauma (AHT) is a leading cause of morbidity and mortality among young children. We aimed to evaluate the long-term impact of AHT.
: Using administrative claims from 2000–2018, children <3 years old with documented AHT who had follow-up through ages 5 and 11 years were identified. The primary outcome was incidence of neurodevelopmental disability and the secondary outcome was the effect of age at time of AHT on long-term outcomes.
: 1,165 children were identified with follow-up through age 5; 358 also had follow-up through age 11. The incidence of neurodevelopmental disability was 68.0% (792/1165) at 5 years of age and 81.6% (292/358) at 11 years of age. The incidence of disability significantly increased for the 358 children followed from 5 to 11 years old (+14.3 percentage points, p<0.0001). Children <1 year old at the time of AHT were more likely to develop disabilities when compared to 2 year olds.
: AHT is associated with significant long-term disability by age 5 and the incidence increased by age 11 years. There is an association between age at time of AHT and long-term outcomes. Efforts to improve comprehensive follow-up as children continue to age is important.
: IV

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Research LettersAnnual incidence of shaken impact syndrome in young children

Summary

Eur J Paediatr Neurol

Serious head injury in infants: accident or abuse?

Pediatrics

Research Letters
Annual incidence of shaken impact syndrome in young children