563 - Presenting Anthropometric Data in Pediatric Abusive Head Trauma: Trends and Outcomes

Publication Number: 1541.563

Rachel C. Zuellig, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Ivan E. Saraiva, University of Pittsburgh Hamot Hospital, Erie, PA, United States; Ericka Fink, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Caitlin R. McNamara, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States

Background: Abusive head trauma (AHT) results in disproportionately worse morbidity and mortality compared to accidental traumatic brain injury (aTBI). Weight and height at the distribution extremes may be associated with patient outcomes after TBI.

Objective: To examine the association of anthropometric data with mechanism of TBI injury and outcomes.

Design/Methods: This is a single center, retrospective cohort study including children under 3 years old admitted to the pediatric intensive care unit (ICU) with TBI between 2014-2024. Variables were collected from the electronic health record. The diagnosis of AHT was determined by the child protection team. Presenting characteristics included sex, race/ethnicity, age, height and weight percentiles, Child Opportunity Index score, and preexisting conditions. Hospital course variables included Glasgow Coma Scale score, Injury Severity Score, seizure, multiorgan dysfunction syndrome prevalence, and neuroimaging results. Functional impairment was defined as Functional Status Score (FSS) increase >1 from pre-injury to hospital discharge. Weight and height percentiles were divided into categories ( < 1%, 1-10%, 10-50%, 50-90%, and >90%) and nonparametric analyses were conducted by TBI mechanism. Lasso and multivariable logistic regressions evaluated associations with functional impairment.

Results: Among 958 patients, median age was 5.09 months (IQR 2.1-18.4 months), 39% (n=375) were female, 74% (n=707) were of white race, and 38% (n = 358) had AHT. Presenting weight and height of AHT patients were more frequently < 1% versus aTBI patients (weight: 13% vs 6.7% and height: 25% vs. 12%; both p< 0.001) (Table 1). More AHT patients had functional impairment at discharge (37% vs. 11%, p< 0.001). Amongst both AHT and aTBI cohorts, there was no difference in functional impairment based on weight or height percentile (Table 2). In a regression, controlling for hospital course characteristics, height < 1% was associated with functional impairment in the overall cohort (OR 2.99, IQR 1.54-5.82, p=0.001), in the AHT subcohort (OR 2.56, CI 1.03-6.55, p=0.043), and the aTBI subcohort (OR 3.01, CI 1.02-8.26, p=0.046) (Table 3).

Conclusion(s): Extremely low height percentile was associated with functional impairment in all cohorts. Further work is needed to elucidate the mechanism of this impact and whether it could be mediated by post-injury nutrition.

Table 1
Weight and Height Percentiles in AHT and aTBI

Table 2
Functional Impairment in AHT and aTBI cohorts

Table 3
Lasso and Multivariable Logistic Regression Model: Impairment at Discharge for all Patients