Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Dr. Jim Anderst
Start Date
15-5-2025 11:30 AM
End Date
15-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background:
Some claim that Child Abuse Pediatricians (CAPs) are misdiagnosing a yet-to-be-identified mimic as abusive head trauma (AHT), particularly in ill children with isolated subdural hemorrhage (SDH). Though not diagnostic criteria, specific social stressors have been identified as AHT risk factors. If a yet-to-be-identified mimic is meaningfully present within a group being evaluated for AHT, that group should have fewer AHT risk factors than children with actual AHT. The existence of such a mimic can be assessed by comparing the prevalence of AHT risk factors across groups: CAP-identified mimics, non-ill SDH only, ill SDH only, and SDH plus concomitant suspicious injuries (CSIs). The SDH+CSI group serves as a proxy for abuse.
Objectives/Goal:
We hypothesize that the distribution of AHT risk factors will be: fewer in the CAP-identified mimic group versus the CAP-diagnosed abuse group, no difference between ill SDH only and SDH+CSI groups as these are likely the same condition, and fewer in the non-ill SDH only versus SDH+CSI groups as there are likely undocumented known medical mimics in the non-ill SDH only group such as birth trauma.
Methods/Design:
Retrospective case-control study using Child Abuse Pediatrics Research Network (CAPNET) data from 10 sites over 27 months. As proof of concept, the prevalence of AHT risk factors was compared between all CAPNET subjects with CAP-identified medical mimics and all subjects with intracranial hemorrhage (ICH) and/or fractures diagnosed with abuse. Social risk domains include prior child protective services involvement, prior out-of-home placement, caregiver mental health concerns, caregiver problem substance use, intimate partner violence, criminal history, and insurance status. Comparisons used unadjusted odds ratios with 95% confidence intervals. For social risk comparison across SDH groups, subjects wereonly, Non-ill SDH only, and SDH+CSI. Ill subjects had cardio-respiratory collapse and/or significantly altered consciousness. CSIs were injuries that are highly associated with abuse in the skin, bones, eyes, and abdomen. CAP diagnosis was not considered for SDH study group determination. Prevalence of social risk, demographics, and trauma history were compared between groups using two one-sided equivalence tests with a 20% equivalence margin.
Results:
In the proof of concept, 1058 subjects with known medical mimics had fewer AHT social risk factors than 548 abused subjects with ICH/fracture in 5/7 domains with point ORs from 0.5-0.7 (all p
Conclusions:
Social risk distribution differentiates CAPNET subjects with medical mimics from those without. Social risk distribution largely did not differ between SDH+CSI and Ill-SDH groups, indicating that a yet-to-be-identified mimic is not widely prevalent in the Ill-SDH group. Non-ill appearing subjects with SDH appear to have fewer AHT risks compared to SDH+CSI, supporting possible medical causes in some of these children.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
In Search of the Unknown Mimic of Abusive Head Trauma.
Background:
Some claim that Child Abuse Pediatricians (CAPs) are misdiagnosing a yet-to-be-identified mimic as abusive head trauma (AHT), particularly in ill children with isolated subdural hemorrhage (SDH). Though not diagnostic criteria, specific social stressors have been identified as AHT risk factors. If a yet-to-be-identified mimic is meaningfully present within a group being evaluated for AHT, that group should have fewer AHT risk factors than children with actual AHT. The existence of such a mimic can be assessed by comparing the prevalence of AHT risk factors across groups: CAP-identified mimics, non-ill SDH only, ill SDH only, and SDH plus concomitant suspicious injuries (CSIs). The SDH+CSI group serves as a proxy for abuse.
Objectives/Goal:
We hypothesize that the distribution of AHT risk factors will be: fewer in the CAP-identified mimic group versus the CAP-diagnosed abuse group, no difference between ill SDH only and SDH+CSI groups as these are likely the same condition, and fewer in the non-ill SDH only versus SDH+CSI groups as there are likely undocumented known medical mimics in the non-ill SDH only group such as birth trauma.
Methods/Design:
Retrospective case-control study using Child Abuse Pediatrics Research Network (CAPNET) data from 10 sites over 27 months. As proof of concept, the prevalence of AHT risk factors was compared between all CAPNET subjects with CAP-identified medical mimics and all subjects with intracranial hemorrhage (ICH) and/or fractures diagnosed with abuse. Social risk domains include prior child protective services involvement, prior out-of-home placement, caregiver mental health concerns, caregiver problem substance use, intimate partner violence, criminal history, and insurance status. Comparisons used unadjusted odds ratios with 95% confidence intervals. For social risk comparison across SDH groups, subjects wereonly, Non-ill SDH only, and SDH+CSI. Ill subjects had cardio-respiratory collapse and/or significantly altered consciousness. CSIs were injuries that are highly associated with abuse in the skin, bones, eyes, and abdomen. CAP diagnosis was not considered for SDH study group determination. Prevalence of social risk, demographics, and trauma history were compared between groups using two one-sided equivalence tests with a 20% equivalence margin.
Results:
In the proof of concept, 1058 subjects with known medical mimics had fewer AHT social risk factors than 548 abused subjects with ICH/fracture in 5/7 domains with point ORs from 0.5-0.7 (all p
Conclusions:
Social risk distribution differentiates CAPNET subjects with medical mimics from those without. Social risk distribution largely did not differ between SDH+CSI and Ill-SDH groups, indicating that a yet-to-be-identified mimic is not widely prevalent in the Ill-SDH group. Non-ill appearing subjects with SDH appear to have fewer AHT risks compared to SDH+CSI, supporting possible medical causes in some of these children.
