Introduction: Abusive head trauma (AHT) is known to have high mortality rates (10-40%), but there are very limited studies on developmental outcomes and prognostic factors. This study aims to identify clinical and radiographic markers of traumatic brain injury severity and neurodevelopmental outcomes.

Methods: Retrospective chart review was conducted to include patients less than five years old with expert-confirmed diagnosis of AHT at Texas Children’s Hospital from 3/2018-2/2021. Demographic, clinical and radiographic data was collected, including longitudinal developmental quotients derived from the Capute Scales and gross-motor milestones for 56 of 112 patients with AHT.

Results: Subdural hemorrhage (SDH) was the most common radiographic finding (85%) and shared similar gross motor (GM) and language outcomes but increased rate of visual-motor problem-solving (VMPS) delays (p=0.0237). Tentorial and cerebellar involvement correlated with increasing GM (p= 0.007) and VMPS (p= 0.007) but not language delays. Subarachnoid hemorrhage (SAH) correlated with VMPS delay in all locations except basal cisterns; frontal or cerebellar SAH correlated with increasing GM delay severity (p=0.0302 and p=0.0037, respectively). Hypoxic ischemic injury (HII) shared similar global developmental delays. These delays improved longitudinally, but those with initial profound delays demonstrated higher persistence of GM, VMPS and language deficits (85%, 100% and 100%, respectively).

Conclusion: Presence of tentorial or cerebellar SDH, SAH, or HII on neuroimaging can be utilized as independent markers of AHT severity and correlate with increased severity of early developmental delay. Neuroimaging coupled with early developmental assessments can be utilized as cursory markers of likelihood of neurodevelopmental delay and longitudinal persistence.

Maegan Newell
Baylor College of Medicine / Texas Children's Hospital
United States

Nilesh Desai
Baylor College of Medicine / Texas Children's Hospital
United States

Stephen Kralik
Baylor College of Medicine / Texas Children's Hospital
United States

Medina Oikeh
Baylor College of Medicine / Texas Children's Hospital
United States

Sharon Record
Baylor College of Medicine / Texas Children's Hospital
United States

Kwabena Sarpong
Baylor College of Medicine / Texas Children's Hospital
United States

Sarah Risen
Baylor College of Medicine / Texas Children's Hospital
United States