Significant initial hyperglycemia in young children with intracranial hemorrhage related to abuse.

Abstract

Introduction: Abusive head injury is more common in younger children, with long lasting physical or neurologic impairments seen in many survivors. There is a close relationship between hyperglycemia and head injury, with hyperglycemia associated with worse outcomes. Our hypothesis is that abusive head injury patients are more likely to have significant hyperglycemia.

Methods: This study is a retrospective review of pediatric emergency department patients less than three years with traumatic intracranial hemorrhage. Demographics, laboratory values, and imaging results were recorded.

Results: In total, 179 patients were analyzed. The median initial glucose for abuse patients was 164 mg/dL. The median initial glucose for non-abuse patients was 99 mg/dL. Eight patients had glucose levels greater than 300 mg/dL. All of these patients were abuse victims. The initial glucose level was significant for the diagnosis of child abuse, ICU admission, need for neurosurgical intervention, and mortality.

Discussion: Young children with intracranial hemorrhage and initial glucose levels greater than 300 mg/dL were all found to be abuse victims. A very high initial glucose can prompt a provider to evaluate for abusive head injury. In cases of a sick infant with glucose greater than 300 mg/dl, the consideration of abuse should play a prominent role in the differential.