{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:40:37Z","timestamp":1791250837391,"version":"4.1.0"},"reference-count":57,"publisher":"SAGE Publications","issue":"21-22","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:p>\n                    Abusive head trauma (AHT) is a leading cause of death in infants and toddlers. The objective of this study was to conduct an age-stratified comparison between children with AHT and accidental Traumatic brain injury TBI (aTBI) in the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury (ADAPT) data. Children with severe TBI and an intracranial pressure monitor placed at a study site in the United States were enrolled from February 1, 2014, to September 31, 2017, and subjects &lt;5 years of age and admitted to a US site were selected for analysis. Subjects were stratified by mechanism (\u2018definite\u2019 or \u2018probable\u2019 concern for AHT classified as AHT; \u2018possible\u2019 or \u2018no\u2019 concern for AHT as aTBI) and age (&lt;1 year, 1\u20132.9-years-, 3\u20134.9-years). Clinical data including epidemiological, clinical events, and imaging that occurred before monitor placement were compared. Of the 313 subjects (n = 111 AHT), apnea, seizures, and bilateral fixed pupils were more frequently observed in AHT (35.1% vs. 21.8%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.01; 43.2% vs. 20.8,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001; 31.5% vs. 15.8%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.008). Subdural hemorrhages, midline shift, and ischemia were more frequently observed in AHT (96.4% vs. 73.1%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001; 54.1% vs. 35.0%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.001; 40.9% vs. 12.2%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001) while contusion, subarachnoid hemorrhage and diffuse axonal injury were less frequently observed (20.2% vs. 49.7%; 38.5% vs. 58.4%; 3.7% vs. 20.8%, all\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). Among the patients &lt;1 year-old, there was no difference in apnea and seizures between AHT and aTBI (40.6% vs. 34.3%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.53; 44.9% vs. 40.0%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.63) while ischemia was more commonly observed in AHT (47.1% vs. 20.0%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). AHT subjects exhibited unique clinical characteristics and radiological findings compared to aTBI, even after this age-stratified comparison. Further study is needed on the effects of both guidelines-based and novel therapies for this vulnerable and unique patient population.\n                  <\/jats:p>","DOI":"10.1177\/08977151251366322","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T16:19:45Z","timestamp":1763396385000},"page":"1974-1983","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Severe Pediatric Traumatic Brain Injury Presenting Characteristics: Abusive Versus Accidental Trauma"],"prefix":"10.1177","volume":"42","author":[{"given":"Caitlin R.","family":"McNamara","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel P.","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Luther","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, UT Southwestern, Dallas, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra D.W.","family":"Buttram","sequence":"additional","affiliation":[{"name":"Department of Child Health, Phoenix Children\u2019s Hospital, Phoenix, Arizona, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subramanian","family":"Subramanian","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Neurology, Division of Pediatric Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srikala","family":"Narayanan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Texas Children\u2019s Hospital, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R.","family":"Wisniewski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2627-913X","authenticated-orcid":false,"given":"Patrick M.","family":"Kochanek","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA."},{"name":"Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Miller Ferguson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"Pediatric Abusive Head Trauma: Recommended Definitions for Public Health Surveillance and Research","author":"Parks SE","year":"2012","unstructured":"Parks SE, , Annest JL, , Hill HA, et al. 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