PC2036: Characteristics of Abusive Head Trauma in Young Children Transported by Emergency Medical Services

Background:

Background: Abusive head trauma is a leading cause of death and disability in young children. Characteristics of children presenting with AHT to Emergency Medical Services are not well described. The purpose of this study is to describe patient demographic and clinical factors and EMS primary impression and interventions associated with a diagnosis of AHT in preverbal children.

Methods:

Methods: This is a secondary data analysis of a large Health Data Exchange (HDE) database including EMS data fields and hospital diagnoses. Eligible patient encounters were those aged < 36 months transported from the scene by EMS to a receiving facility over a 2-year period. We excluded scene deaths, refusals, against medical advice, and aeromedical transports. Our primary outcome was the prevalence of AHT and secondary outcomes include patient demographics (median age, gender), EMS primary impression and interventions, and patient disposition.

Results:

Results: Over the study period, there were 179,546 encounters of children < 36 months of which 624 had a hospital diagnosis of AHT (0.35%). Median age was 1 year (0-2), 53% were male, median EMS GCS was 15, and 47% were transported by ALS. Median scene time and transport time were 11.7 and 14.5 minutes, respectively. WithIn our cohort, 79.3% (n=495) were coded as being a "traumatic" encounter with the following top 5 EMS primary impressions: Injury of Head/Face (35.7%), Traumatic Injury (21.3%), Injury (31.2%), No Complaints or Injury/Illness Noted (7.3%), and Laceration/Abrasion/Hematoma (2.3%). Overall, 7.5% had IV access (n=47), yet only 2.4% (n=15) received a medication; 7.5% received airway management most receiving supplemental oxygen (63%). Top medications included epinephrine (n=7), benzodiazepines (n=6), and analgesics (n=6). Non-febrile seizures accounted for 13 encounters of which half received midazolam. Overall, 12% of patients were admitted and among those with a documented hospital length of stay, the median was 3 days. A total of 6 patients (1%) died.

Conclusion:

Conclusion: In our dataset, most EMS transports of children with AHT have an EMS impression of trauma however, 1 in 5 were classified as a medical condition. EMS performed very few interventions and treatments despite a significant number requiring hospital admission. AHT remains an occult diagnosis in preverbal children and further research characterizing EMS clinical impressions and rationale for treatment decisions in this high-risk patient population are needed.