Abstract Details

Title Invisible Scars: Exploring the Pervasiveness of Abusive Head Trauma in Texas

Topic Neuro Trauma and Critical Care

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-003

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.

Authors/Disclosures
Joshua A. Beitchman, MD, MBS (UT Southwestern Medical Center) PRESENTER	Dr. Beitchman has nothing to disclose.
Aleksandr Pereverzev	Mr. Pereverzev has nothing to disclose.
Katherine Giordano	Dr. Giordano has nothing to disclose.
Matthew Ho, BS	Mr. Ho has nothing to disclose.
Kathleen R. Bell, MD	The institution of Dr. Bell has received research support from NIDILRR. Dr. Bell has received research support from Baylor Scott and White Research. Dr. Bell has received research support from Seattle Children's Medical Center.
Suzanne Dakil, MD	Dr. Dakil has nothing to disclose.
Jonathan Lifshitz, PhD (University of Michigan)	Prof. Lifshitz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Mission Connect - TIRR Foundation. Prof. Lifshitz has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Prof. Lifshitz has received research support from National Institutes of Health, Department of Defense, Veterans Administration, and state funding.
Lee Shapiro, PhD	Mr. Shapiro has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Mr. Shapiro has received research support from DOD.
Mathew Stokes, MD (University of Texas SW Medical School, Child Neurology)	The institution of Dr. Stokes has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Global Medical Response.

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