Available online 9 May 2024, 101142

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Abusive head trauma (AHT) is associated with high mortality and poorer outcomes compared to accidental head injuries. The short and long-term developmental outcomes for AHT are not well identified. Variability in outcome measures, small sample sizes, difficulty in measuring domain-specific developmental skills, co-existence of comorbidities, genetic and environmental factors and high attrition rates all contribute to the challenges on providing data in this area. The objective of this article is to review the scientific literature on the developmental outcomes of AHT, highlighting factors that affect outcomes, the available assessment tools, and short and long-term developmental outcomes, recommended follow up, societal costs, and future opportunities for research. Authors searched OVID Medline and PubMed for articles published between 2013-2023 using the terms “abuse”, “craniocerebral trauma” and “development”. Fifty-five records were included for this review. The data shows that injuries sustained from AHT result in a spectrum of outcomes ranging from normal development to death. There are more than 100 outcome assessment tools limiting the ability to compare studies. More than half of patients are left with disabilities post discharge. Gross motor and cognition/academics are the 2 most common domains studied. Advancement in surgical and neurocritical care management has influenced AHT outcomes. Close long-term follow up is recommended to maximize each child's developmental potential, irrespective of the presence of disability at discharge. We suggest that future research should focus on adopting a consistent diagnostic and assessment approach and explore the social environmental factors that can affect recovery.

Section snippetsTerminology

Multiple terms have been used to describe what is now referred to as Abusive Head Trauma (AHT). These include Shaken Baby Syndrome, whiplash-shaking injury, or Shaken Impact Syndrome. In 2009, the American Academy of Pediatrics published a policy statement favoring the term AHT as more inclusive of the variety of traumatic mechanisms that lead to injury, including both impact and shaking events [1]. The Centers for Disease Control and Prevention (CDC) defines AHT as any head injury to a child <

DEVELOPMENTAL OUTCOMES

Injuries from AHT result in a spectrum of outcomes ranging from normal development to death. The CDC estimates 25% to 30% of those with AHT die acutely, while 15% survive without any sequelae, leaving most patients with a disability [32]. A cohort study of 940 children showed that 72% of children who were exposed to AHT developed a long-term disability by age 5 [33].

Studies addressing developmental outcomes following AHT have variable inclusion criteria, age range, outcome measures, and follow

CRediT authorship contribution statement

Dina Ahmad: Writing – review & editing, Writing – original draft, Visualization, Resources, Methodology, Conceptualization. Amanda Small: Writing – review & editing, Writing – original draft, Visualization, Resources, Methodology, Conceptualization. Ashley Gibson: Writing – review & editing, Methodology, Conceptualization. Natalie Kissoon: Writing – review & editing, Supervision, Methodology, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We thank Dr. Sarah Risen, assistant professor in Pediatric Neurology at Baylor College of Medicine, for her expert review of the manuscript. We also thank Sonya Fogg, librarian at the Texas Medical Center library, for providing advice about literature search methodology.

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