G503(P) Retrospective data analysis of children admitted with non-accidental head injury (NAHI) in a tertiary children’s hospital

Background NAHI (Non-accidental Head Injury) is the most common cause of death from inflicted injury in children. Non- accidental head trauma is a form of physical child abuse and should be suspected in any case where there is lack of history of trauma or insufficient history to explain a child’s injuries. Aims The aim of this audit is to review clinical outcomes in children admitted with suspected NAHI between January 2011 and December 2015. Methods All children,referred to the child protection team for suspected NAHI between January 2011 and December 2015, were identified from the database. Results 33 children were identified and mean age at injury was 6.9 months (range 3 weeks to 48 months). Presentation was diverse, however the most common presenting feature was acute life threatening event (42%). Males (79%) were affected more than females (21%). 13 (40%) children were admitted to PICU (Paediatric Intensive Care Unit). 4 (12%) children died. Among the 29 (88%) children who survived non-accidental head injury, 14 (48%) were diagnosed with Shaken Baby Syndrome. 5 (17%) children needed burrhole as surgical intervention. Retinal haemorrages were seen in 16 (55%) children and sub-dural haematomas in 23 (79%). In terms of clinical outcomes, 20 (69%) children were discharged from follow up from the neuro-surgeons. 1 (3%) child developed epilepsy, 2 (7%) children had ventriculo-peritoneal shunt insertion and 6 (20%) children developed cerebral palsy secondary to the hypoxic changes in the brain and were naso-gastric feeds dependant. Among the 6 children diagnosed with cerebral palsy, 5 developed seizures needing anti-epileptic medications and 2 had visual impairment. Families of 2 children were known to police for history of domestic violence in the family. 1 child had Down’s syndrome. None of the children were on child protection plan prior to the injury. Conclusion Majority of children who suffered NAHI were infants with boys being more commonly affected than females. 9 (31%) children developed long term neurological sequelae and 20 (69%) children had good clinical outcome. NAHI diagnosis requires a meticulous mult-idisciplinary approach.