Clinical characteristics, neurosurgical management, and outcomes of pediatric abusive head trauma: a 30-year single-center study.

PURPOSE: Abusive head trauma (AHT) is a leading cause of severe brain injury, mortality and long-term neurological disability in infants. Data on clinical indicators for neurosurgical intervention and long-term neurological outcome remain limited. This study aimed to describe clinical characteristics, indicators for neurosurgical management, and long-term outcomes of pediatric AHT. METHODS: We conducted a retrospective single-center cohort study including all children younger than two years with suspected or confirmed AHT between 1993 and 2024. Clinical, radiological, treatment, and outcome data were extracted from medical records. Neurological outcome was assessed using the Pediatric Cerebral Performance Category (PCPC) score at discharge and last follow-up. RESULTS: A total of 101 children presenting at University Hospitals of Leuven were included. Neurosurgical intervention was required in 72% of patients, and overall mortality was 11%. At last follow-up, neurological outcome was good in 67 patients (68%), intermediate in 12 patients (12%), and poor (including death) in 19 patients (19%). Among the 72 surgically treated patients, 64 (89%) underwent subdural external drainage. The median duration of drainage was 9 days (range 1-41), requiring a re-evacuation in 21%. Of all symptoms, only bulging fontanelle was independently associated with neurosurgical intervention (OR 3.19, 95% CI 1.25-8.13, p = 0.015). Cerebral edema or ischemia was the strongest independent determinant of poor neurological outcome (OR 38.69, 95% CI 6.92-216.35, p < 0.001). CONCLUSION: Abusive head trauma in early childhood is associated with substantial mortality and long-term neurological morbidity. A prospective multicenter study is needed to further refine surgical decision-making.