Citation

Rennert RC, Levy ML. Neurosurgery 2020; ePub(ePub): ePub.

Affiliation

Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, California.

Copyright

(Copyright © 2020, Congress of Neurological Surgeons)

DOI

10.1093/neuros/nyaa153

PMID

32374846

Abstract

Abusive head trauma (AHT) is a complex and challenging problem for pediatric neurosurgeons. Recent efforts have been made to better understand the epidemiology, hospitalization needs, and costs of pediatric AHT when stratified by injury severity, as well as identify predictors of outcome.1-3 Despite the finding that multiple risk injury severity scores, including the Pediatric Risk of Mortality II (now in its fourth iteration), Glascow Coma Scale, and Pediatric Coma Score correlated with survival,2 more granular data on the most pertinent clinical risk factors affecting outcomes other than death has been limited. Ajmera et al4 should thus be commended for their work identifying specific predictors of clinically relevant outcomes following pediatric AHT. Specifically, the presence of uni- or bilateral mydriasis (dilated pupils), seizures, increasing international normalized ratio (indicating coagulopathy), and/or decreasing hematocrit were associated with one or more of the clinical outcomes of death or hemispheric stroke, stroke of any kind, or need for neurosurgical intervention. Notable variables that did not correlate with the above outcomes on multivariate analysis were age, race, insurance status, and fontanelle exam.

The true value of this study4 is its distillation of data into an easily interpretable format for clinicians. The initial diagnosis of AHT is often delayed due to variability in clinical findings and commonly poor or misleading clinical histories. Correlative injury severity scores are also either cumbersome, limiting their real-time interpretation, or an oversimplification of the presenting neurologic exam that most effectively identifies severe injuries but may miss more moderately injured patients that may benefit from neurosurgical consultation. The identification of a clear set of presenting variables in possible AHT patients that if present should alert front line providers ...

Language: en