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Long-term outcome of paediatric abusive head trauma : 15 years perspective in a portuguese university hospital
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Introdução: O traumatismo craniano abusivo infantil (TCA) define-se por lesões do crânio e parênquima resultantes de traumatismo contundente direto ou abanão violento afetando crianças abaixo dos 5 anos. Esta condição potencialmente prevenível apresenta mau prognóstico, incluindo mortalidade infantil e incapacidades graves nos âmbitos neuromotor, visual e cognitivo-comportamental.
Objetivos: Avaliar possíveis desfechos de TCA após alta hospitalar e compreender eventuais correlações com características clínicas e sociodemográficas que poderão prever o seu prognóstico.
Métodos: Revisão retrospectiva que incluiu a recolha e análise de registos médicos de crianças vítimas de TCA internadas na Unidade de Cuidados Intensivos Pediátricos (UCIP) de um hospital universitário português entre 2007-2022, assim como os respetivos registos de seguimento. Foi utilizada a escala KOSCHI para classificar o prognóstico de neurodesenvolvimento global.
Resultados: Catorze rapazes e 7 raparigas foram incluídos. A idade mediana à admissão foi de 6 meses. A análise aos antecedentes familiares revelou 92% das mães com baixo nível educacional e, em 36% dos casos, pelo menos um dos progenitores encontrava-se desempregado. A maioria das crianças revelou, à admissão, alteração do estado de consciência (86%). Hematoma subdural, lesão parenquimatosa e hemorragias retinianas bilaterais foram descritas na maioria das crianças (86%, 71% e 68%, respectivamente). Quarenta e três por cento revelaram um mau desfecho a longo prazo e cinco vítimas faleceram. Défices visuais e cognitivo-comportamentais representaram as sequelas a longo prazo mais frequentes. Constatou-se que um baixo valor na Escala de Coma de Glasgow (GCS) à admissão, um maior tempo de estabilização médico-legal das lesões neurológicas e consequências neuromotoras, cognitivo-comportamentais ou epilepsia se associam significativamente a um pior prognóstico (p>0,05).
Conclusões: Este estudo confirma a elevada morbimortalidade associada ao TCA e a importância de alertar profissionais de saúde relativamente ao abuso infantil, o seu diagnóstico, denúncia e à reabilitação dos sobreviventes.
Background: Paediatric abusive head trauma (AHT) is defined as an injury to the skull or intracranial contents affecting children under 5 years old from a blunt impact and/or violent shaking. This preventable condition has a poor long-term prognosis, including infant mortality and severe permanent disability such as neuromotor, visual, cognitive and/or behavioural impairments. Purpose: To evaluate the possible outcomes of AHT following hospital discharge and understand plausible correlations between the clinical and sociodemographic features that could help predict their long-term prognosis. Methods: Through a retrospective chart review, medical records from paediatric victims of AHT admitted to a Portuguese university hospital’s paediatric intensive care unit (PICU) between 2007-2022, as well as their subsequent follow-up records were collected and analysed. The KOSCHI scale was used to classify global neurodevelopmental outcomes. Results: Fourteen boys and seven girls were included in the review. The median age at admission was 6 months. Familiar background analysis revealed 92% of mothers with low educational status and 36% of victims had at least one parent unemployed. Most children presented with altered mental status (86%). Subdural haematoma, parenchymal brain injury and bilateral retinal haemorrhages were reported for the majority of children (86%, 71% and 68%, respectively). Forty-three per cent had a long-term poor global outcome and five victims died. Visual, behavioural and cognitive deficits accounted for the most common long-term sequelae. It was found that a lower Glasgow Coma Scale (GCS) at admission, a longer time until medico-legal stabilisation of neurological lesions, long-term neuromotor, behavioural and cognitive impairments and epilepsy were significantly correlated with a poorer global outcome (p<0,05). Conclusions: This review confirmed the high long-term morbidity and mortality associated with AHT and the importance of medical professionals’ awareness of child abuse, its diagnosis, report and survivors’ rehabilitation.
Background: Paediatric abusive head trauma (AHT) is defined as an injury to the skull or intracranial contents affecting children under 5 years old from a blunt impact and/or violent shaking. This preventable condition has a poor long-term prognosis, including infant mortality and severe permanent disability such as neuromotor, visual, cognitive and/or behavioural impairments. Purpose: To evaluate the possible outcomes of AHT following hospital discharge and understand plausible correlations between the clinical and sociodemographic features that could help predict their long-term prognosis. Methods: Through a retrospective chart review, medical records from paediatric victims of AHT admitted to a Portuguese university hospital’s paediatric intensive care unit (PICU) between 2007-2022, as well as their subsequent follow-up records were collected and analysed. The KOSCHI scale was used to classify global neurodevelopmental outcomes. Results: Fourteen boys and seven girls were included in the review. The median age at admission was 6 months. Familiar background analysis revealed 92% of mothers with low educational status and 36% of victims had at least one parent unemployed. Most children presented with altered mental status (86%). Subdural haematoma, parenchymal brain injury and bilateral retinal haemorrhages were reported for the majority of children (86%, 71% and 68%, respectively). Forty-three per cent had a long-term poor global outcome and five victims died. Visual, behavioural and cognitive deficits accounted for the most common long-term sequelae. It was found that a lower Glasgow Coma Scale (GCS) at admission, a longer time until medico-legal stabilisation of neurological lesions, long-term neuromotor, behavioural and cognitive impairments and epilepsy were significantly correlated with a poorer global outcome (p<0,05). Conclusions: This review confirmed the high long-term morbidity and mortality associated with AHT and the importance of medical professionals’ awareness of child abuse, its diagnosis, report and survivors’ rehabilitation.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Traumatismo craniano abusivo Síndrome do bebé abanado Traumatismo craniano não-acidental Abuso infantil Prognóstico de desenvolvimento global Pediatria