title: Risk factors for mortality in children with abusive head trauma.
abstract: OBJECTIVE
  We sought to identify risk factors for mortality in a large clinical cohort of children with abusive head trauma.
  
  
  METHODS
  Bivariate analysis and multivariable logistic regression models identified demographic, physical examination, and radiologic findings associated with in-hospital mortality of children with abusive head trauma at 4 pediatric centers. An initial Glasgow Coma Scale (GCS) ≤ 8 defined severe abusive head trauma. Data are shown as OR (95% CI).
  
  
  RESULTS
  Analysis included 386 children with abusive head trauma. Multivariable analysis showed children with initial GCS either 3 or 4-5 had increased mortality vs children with GCS 12-15 (OR = 57.8; 95% CI, 12.1-277.6 and OR = 15.6; 95% CI, 2.6-95.1, respectively, P < .001). Additionally, retinal hemorrhage (RH), intraparenchymal hemorrhage, and cerebral edema were independently associated with mortality. In the subgroup with severe abusive head trauma and RH (n = 117), cerebral edema and initial GCS of 3 or 4-5 were independently associated with mortality. Chronic subdural hematoma was independently associated with survival.
  
  
  CONCLUSIONS
  Low initial GCS score, RH, intraparenchymal hemorrhage, and cerebral edema are independently associated with mortality in abusive head trauma. Knowledge of these risk factors may enable researchers and clinicians to improve the care of these vulnerable children.
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15260, USA. drstevenshein@gmail.com
authors.forename: Steven L
authors.initials: SL
authors.lastname: Shein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Tyler-Kabara
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Kenneth
authors.initials: K
authors.lastname: Feldman
authors.forename: Kathi
authors.initials: K
authors.lastname: Makoroff
authors.forename: Philip V
authors.initials: PV
authors.lastname: Scribano
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Berger
mesh_terms: D001929:Brain Edema / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000401:mortality*; D006259:Craniocerebral Trauma / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D020200:Hematoma, Subdural, Chronic / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012166:Retinal Hemorrhage / Q000453:epidemiology; D012307:Risk Factors