Invisible Scars: Exploring the Pervasiveness of Abusive Head Trauma in Texas
Joshua Beitchman1, Aleksandr Pereverzev2, Katherine Giordano3, Matthew Ho2, Kathleen Bell1, Suzanne Dakil1, Jonathan Lifshitz3, Lee Shapiro2, Mathew Stokes1
1University of Texas Southwestern Medical Center, 2Texas A&M University College of Medicine, 3University of Arizona College of Medicine - Phoenix
Objective:
This study characterized the pervasiveness of pediatric head trauma and traumatic brain injuries related to abuse in Texas.
Background:
Mild traumatic brain injuries (mTBI) in children due to abuse are severely underreported. Abuse-related mTBI occurs across age, sex, race, or sociodemographic status. Additionally, child abuse survivors are at risk for repetitive mTBI, delayed diagnosis, and inadequate rehabilitation.
Design/Methods:
A retrospective analysis was conducted using deidentified discharge data from all licensed Texas hospital facilities (inpatient, outpatient, emergency) from 2016-2021. Co-occurring ICD-10 codes related to mTBI and child abuse were used to define abuse-related mTBI and abusive head trauma (AHT) in children (ages 0-18). Population-level statistics were calculated to characterize the prevalence of abuse-related head injuries.
Results:
We found 581,142 occurrences of head trauma in children with 471,082 identified as mTBI. 0.5% of injuries (143 mTBI; 2486 AHT) were related to abuse. Ages 0-4 were most at risk, with a male (60%) predominance. Children were more likely to be identified by inpatient facilities followed by outpatient clinics and emergency departments. Children identified as Caucasian/Not-Hispanic (33%), Caucasian/Hispanic (31%), and Black/Not-Hispanic (20%) were most often diagnosed with abuse-related head trauma. However, Black/Not-Hispanic children represented a larger proportion compared with the demographics of children diagnosed with mTBI. Network plots of children with abusive head trauma revealed strong associations among codes related to intracranial pathology, seizures, and musculoskeletal injuries. Injuries were prevalent throughout the state, with the highest occurrence of injuries observed in metropolitan areas.
Conclusions:
Pediatric abuse-related mTBI in Texas was most often detected when admitted to inpatient facilities but is likely underrecognized when compared to national data. Delayed detection of abuse-related injuries place children at risk for repetitive TBIs and persistent mTBI-induced symptoms. Improved awareness of children who sustain abuse-related TBI is necessary to promote earlier diagnosis and initiation of multidisciplinary rehabilitation.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.