Early neurobehavioral outcomes in patients with suspected abusive head trauma receiving inpatient neurorehabilitation

Abstract

Background: Patients with suspected abusive head trauma have worse neurobehavioral outcomes than patients with accidental mechanisms of brain injury and at times receive inpatient rehabilitation. However, precise information regarding outcomes among this patient population prior to discharge from an inpatient rehabilitation unit is largely unavailable. Objective: To describe neurobehavioral outcomes using a standardized and norm referenced measure and examine factors related to these outcomes among patients with presumed abusive head trauma who were receiving inpatient rehabilitation. Design: This study involved retrospective review/analysis. Setting: Participants were assessed during their admission to a large inpatient rehabilitation unit housed within an academic medical center. Participants: Participants included 45 pediatric patients admitted and evaluated between 2016 and 2022. Interventions: This study did not investigate intervention(s). Main Outcome Measure(s): The participants' neurobehavioral outcomes were assessed via the Mullen Scales of Early Learning, American Guidance Service (AGS) Edition. Results: The sample's global neurobehavioral functioning was below average, which was also the case for early visuospatial processing, receptive language, and gross motor abilities. Expressive language and fine motor abilities were comparatively intact. Developmental/age- and time-based variables were the best predictors of global neurobehavioral outcomes. Older age at injury and assessment, lengthier inpatient rehabilitation unit admission, and longer time between injury and assessment were predictive of worse outcomes. Conclusions: These findings are somewhat discrepant from the brain injury literature but may be associated with two, possibly interrelated, factors including age-based performance expectations on assessment and high medical morbidity specific to this patient population. These findings are consistent with the well-documented tendency for infants and toddlers with early brain pathology to exhibit increased neurobehavioral deficits over time.