Abusive head trauma in children presenting with an apparent life-threatening event.
OBJECTIVE
To identify rates of abusive head trauma and associated clinical risk factors in patients with an apparent life-threatening event (ALTE).


METHODS
Retrospective study of infants, 0 to 12 months, admitted for an apparent life-threatening event (ALTE; 1999-2003). Patients with abusive head trauma were identified at presentation or on follow-up; statistical analysis identified characteristics associated with abusive head trauma.


RESULTS
Of 627 patients with ALTE, 48% were male. Nine (1.4%) were diagnosed with abusive head trauma, of whom 5 were diagnosed in the emergency department. All cases detected in the emergency department had physical examination findings indicative of abusive head trauma. Patient age, male sex, or ethnicity were not significantly different between those with and without abusive head trauma. More children with abusive head trauma had a documented 911 call (56% vs 22%, P = .029), vomiting (56% vs 19%, P = .018), or irritability (22% vs 3%, P = .033). Multivariate analysis revealed odds ratio for abusive head trauma were 4.9 with a 911 call (P = .037), 5.3 with vomiting (P = .024), and 11.9 with irritability (P = .0197).


CONCLUSIONS
Abusive head trauma is in the differential for infants with an ALTE, although almost half of the cases are missed by current emergency department management. Vomiting, irritability, or a call to 911 are significantly associated with heightened risk for abusive head trauma.
Division of Pediatric Emergency Medicine, University of Utah, School of Medicine, Salt Lake City, UT 84158, USA. Guenther@hsc.utah.edu
Elisabeth
E
Guenther
Annie
A
Powers
Rajendu
R
Srivastava
Joshua L
JL
Bonkowsky
D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data*; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000453:epidemiology*; D004630:Emergencies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors