G54(P) Disability and visual outcomes following abusive head trauma (AHT) in children under 2 years

Aim The primary objective was to report immediate and long-term disability outcomes in children following an abusive head trauma (AHT) aged less than 2 years. The secondary objective was to report visual outcomes. Methods A retrosepctive study that identified children from the Ophthalmology Department’s database of children examined for suspected AHT, between 1995 and 2017. Children were included if they were aged 24 months or less, with no pre-existing visual or developmental problems, and if their injury was confirmed as a result of AHT. This was determined by the conclusion of the local Multi-Disciplinary Team. Ethical approval was obtained. KOSCHI (King’s Outcome Score of Head Injury) was used to assess disability outcomes at discharge from hospital and at long-term follow up. A retinal haemorrhage score (0 to 16) recorded extent of retinal injury. Visual function (normal, visual impairment, no functional vision) was assessed at follow up. Results Total of 44 children (25 male 19 female) with a median age of 16 weeks. Subdural haemorrhage was seen in 98% (37% bilateral); 56/% had additional injuries on skeletal survey. At discharge, 5% children had died (KOSCHI 1) or were in vegetative state (KOSCHI 2); 61% showed features of moderate to severe disability (KOSCHI 3 & 4); 34% had a ‘good or full recovery’ (KOSCHI 5). At long-term follow-up, 14% showed a worsening of their KOSCHI score. This resulted in overall outcomes of 71% disability and 29% full recovery, at a mean age of 5.3 years. Retinal haemorrhages were present in 93%, 88% bilaterally (mean score 8). At follow-up, visual impairment was present in 31%, 7% of whom had no functional vision. Conclusion AHT continues to give rise to significant morbidity; this cohort showed a worsening of disability score at long-term follow-up. This indicates disability severity may not be fully appreciated at discharge from hospital, impacting on both provision of accurate prognostic information and in applying targeted follow-up. Visual impairment was more severe in those with a higher retinal haemorrhage score, as might be expected in more extensive injury. As there are few visual outcome studies, this adds to the evidence base, and we would promote that services should ensure visual function is optimised.