The Cushing Neuroscience Institutes and the Department of Neurosurgery, Hofstra North Shore - LIJ School of Medicine at (‡)Cohen Children's Medical Center and the North Shore - Long Island Jewish Health System, Manhasset, NY 11030.
BACKGROUND: Children who sustained non-accidental head trauma (NAHT) are at severe risk for mortality within the first 24 hours after presentation.
OBJECTIVE: Extent of delay in seeking medical attention may be related to patient outcome.
METHODS: A ten year, single-institution, retrospective review of 48 cases treated at a large tertiary Children's Hospital reported to the New York State Central Registrar by the child protection team was conducted. The perpetrator was identified in 28 cases based on confession or conviction. The medical and legal records allowed for identification of time of injury and the interval between injury and arrival to the hospital; this information was categorized as follows: <6 hours (without delay); 6-12 hours (moderate delay); >12 hours (severe delay). The King's Outcome Scale for Childhood Head Injury (KOSCHI) score was recorded for each case.
RESULTS: All children were three years of age or younger (2.1 - 34 months) and predominantly male (68%; 19/28). 61% of patients (17/28) presented with moderate or severe delay in arrival. A low arrival Glasgow Coma Scale (GCS) score (p<0.0001) and extracranial injuries (p<0.0061) correlated with worse clinical patient outcomes. Patients with an arrival GCS score <7 predominantly arrived without delay or with moderate delay. Patients presenting without delay or with severe delay were more likely to have a higher KOSCHI outcome score upon discharge (p<0.0426). Four of the six patients who died presented after moderate delay.
CONCLUSION: Patients presenting to medical care 6-12 hours after NAHT (moderate delay) appeared to have worse outcomes than those presenting earlier or later.