Clinical Features of Children with Abusive Head Injury and Apparent Life-Threatening Events Upon Presentation to a Children’s Hospital

Background: The symptoms of child abuse and ALTE are similar. Diagnosing child abuse in those who present with an ALTE may be difficult since the symptoms are similar, and bruising is not always seen in those abused. Approximately only 50% of infants who have bruising are found to be abused. There is limited literature showing bruises to the face or blood in the nose or mouth are distinguishing features of those abused infants who initially present to the Emergency Department (ED) for ALTE. Objective: To determine if bruises or contusions to the face or body in infants occur more often in those who present to the ED as an ALTE but found to have Abusive Head Injury (AHI) versus those who present as ALTE and not found to have AHI. A secondary aim was to determine if blood in the mouth and/or nose was present in those with ALTE but found to have AHI. Methods: Retrospective case-control study of infants Results: There were 49 patients in the study: 20 AHI and 29 non-AHI. All infants in both groups had apnea as a presenting symptom. There were no differences in race or gender between groups. No patients in the non-AHI group had retinal hemorrhages. There was not a significant difference in CPR performed prior to arriving to the ED between groups. Intubation was performed with higher frequency in the AHI patients than non-AHI patients (62% vs 0%, p=0.002 by Fisher’s Exact Test). All nine patients requiring intubation were in the AHI group and had intracranial bleeds. Bruises were present with higher frequency in the abused than non-abused group (31% vs 0%, P=0.017 by Fisher’s Exact Test). All bruises were found on patients’ bodies and none on their faces. There were 2 patients with blood from the nose but those were in the non-AHI group and had received CPR. Conclusions: Infants with ALTE who have AHI are more likely to present with bruising to the body, retinal hemorrhages, and intracranial bleeds than infants who have AHI. Blood in the nose does not identify those with AHI. The performance of CPR does not differentiate between groups but the need for intubation was associated with AHI.