title: The Anesthesiologist's Role in Treating Abusive Head Trauma.
abstract: Abusive head trauma (AHT) is the most common cause of severe traumatic brain injury (TBI) in infants and the leading cause of child abuse-related deaths. For reasons that remain unclear, mortality rates after moderate AHT rival those of severe nonintentional TBI. The vulnerability of the developing brain to injury may be partially responsible for the poor outcomes observed after AHT. AHT is mechanistically more complex than nonintentional TBI. The acute-on-chronic nature of the trauma along with synergistic injury mechanisms that include rapid rotation of the brain, diffuse axonal injury, blunt force trauma, and hypoxia-ischemia make AHT challenging to treat. The anesthesiologist must understand the complex injury mechanisms inherent to AHT, as well as the pediatric TBI treatment guidelines, to decrease the risk of persistent neurologic disability and death. In this review, we discuss the epidemiology of AHT, differences between AHT and nonintentional TBI, the severe pediatric TBI treatment guidelines in the context of AHT, anesthetic considerations, and ethical and legal reporting requirements.
authors.affiliation: From the *Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology, Johns Hopkins University, Baltimore, Maryland; †Department of Pediatrics, Anesthesia, and Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; and ‡Departments of Anesthesiology and Pediatrics, Children's National Health System, Washington DC.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Lee
authors.forename: Ken M
authors.initials: KM
authors.lastname: Brady
authors.forename: Nina
authors.initials: N
authors.lastname: Deutsch
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D000072080:Anesthesiologists; D001921:Brain / Q000000981:diagnostic imaging / Q000254:growth & development*; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002423:Cause of Death; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000401:mortality; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D019221:Mandatory Reporting; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D024382:Professional Role; D012307:Risk Factors; D016896:Treatment Outcome