title: Functional outcomes in children with abusive head trauma receiving inpatient rehabilitation compared with children with nonabusive head trauma.
abstract: OBJECTIVE
  To compare clinical features and functional outcomes of age- and sex-matched children with abusive and nonabusive head trauma receiving inpatient rehabilitation.
  
  
  METHODS
  Children with abusive head trauma (n = 28) and age- and sex-matched children with nonabusive head trauma (n = 20) admitted to an inpatient pediatric rehabilitation unit from 1995-2012 were studied. Acute hospitalization and inpatient rehabilitation records were retrospectively reviewed for pertinent clinical data: initial Glasgow Coma Scale score, signs of increased intracranial pressure, neuroimaging findings, and presence of associated injuries. Functional status at admission to and discharge from inpatient rehabilitation was assessed using the Functional Independence Measure for Children. Outcome at discharge and outpatient follow-up were described based on attainment of independent ambulation and expressive language.
  
  
  RESULTS
  Children with abusive and nonabusive head trauma had similar levels of injury severity, although associated injuries were greater in those with abusive head trauma. Functional impairment upon admission to inpatient rehabilitation was comparable, and functional gains during inpatient rehabilitation were similar between groups. More children with nonabusive than with abusive head trauma attained independent ambulation and expressive language after discharge from rehabilitation; the difference was no longer significant when only children aged >12 months at injury were examined. There was variability in delay to obtain these skills and in the quality of gained skills in both groups.
  
  
  CONCLUSIONS
  Despite more associated injuries, children with abusive head trauma make significant functional gains during inpatient rehabilitation, comparable with an age- and sex-matched sample with nonabusive head trauma. Key functional skills may be gained by children in both groups following discharge from inpatient rehabilitation.
authors: Kennedy Krieger Institute, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Sarah R
authors: SR
authors: Risen
authors: Kennedy Krieger Institute, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: suskauer@kennedykrieger.org.
authors: Stacy J
authors: SJ
authors: Suskauer
authors: VA Medical Center, Perry Point, MD.
authors: Ellen J
authors: EJ
authors: Dematt
authors: Kennedy Krieger Institute, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Beth S
authors: BS
authors: Slomine
authors: Kennedy Krieger Institute, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Cynthia F
authors: CF
authors: Salorio
mesh_terms: D000704:Analysis of Variance; D016022:Case-Control Studies; D002649:Child Abuse; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007804:Language Development; D007902:Length of Stay; D008297:Male; D063868:Patient Outcome Assessment; D020127:Recovery of Function; D012189:Retrospective Studies; D016138:Walking