Longitudinal functional outcomes in abusive head trauma versus accidental traumatic brain injury

Introduction: Children who suffer abusive head trauma (AHT) are at high risk of morbidity and mortality. We hypothesized that children after AHT would have a higher incidence of new impairment compared to children after accidental traumatic brain injury (aTBI) at discharge, 1 y, and 5 y post-discharge. Methods: Children < 3y old admitted with TBI to the Pediatric Intensive Care Unit (PICU) at a Level 1 Trauma Center between 2014-2019 were included. Patient and injury characteristics, TBI mechanism (abuse vs. accident) and Functional Status Scale (FSS) scores (pre-TBI, hospital discharge, and 1 and 5 y post-discharge) were abstracted from the electronic health record. New impairment was defined as change in FSS > 2 from baseline. Patients who died were assigned the highest FSS score. Multivariate logistic regression was performed to determine variables associated with new impairment at hospital discharge, 1 y, and 5 y post-discharge. Results: Three-hundred and sixteen patients (160 AHT, 156 aTBI) were included in this study of which 13 children with AHT and 3 children with aTBI died. The mean age for each group was 7 mo (2, 25) for aTBI and 4 mo (2, 9) for AHT. Children with AHT had worse admission Injury Severity Scores (ISS) compared to aTBI (10 [9, 17] vs. 17 [10, 26], p