Abusive Head Trauma in Turkey and Impact of Multidisciplinary Team Establishment Efforts on Case Finding and Management: Preliminary Findings

• Main Authors: Serpil Yaylacı, Yıldız Dallar, Yavuz Sayar, Medine Ayşin Taşar, Ülkü Tıraş, Deniz Tekin, Ağahan Ünlü, Betül Ulukol, Fatma Yücel Beyaztaş, Celal Bütün, Ünal Özüm, Bora Büken, Ferhan Kandemir, Ahmet Gökoğlu, Meda Kondolot, Ahmet Menkü, Türkan Patıroğlu, Aydın Tunç, Fatih Yağmur, Ali Yıkılmaz, Taner Akar, Ufuk Beyazova, Bülent Değirmenci, Elvan İşeri, Figen Şahin, Aysun Baransel Isır, Ayşe Gül Bilen, Resmiye Oral, Nurperi Gazioğlu, Yasemin Balcı, Mesut Eryürük, Feyza Karagöz
• Format: Article
• Language: English
• Published: Galenos Yayinevi 2016-03-01
• Series: Eurasian Journal of Emergency Medicine
• Subjects: Abusive head trauma; multidisciplinary team; diagnostic workup
• Online Access: http://akademikaciltip.com/archives/archive-detail/article-preview/abusive-head-trauma-in-turkey-and-mpact-of-multidi/21838

Aim: Abusive head trauma (AHT) is the most common cause of death as the result of child abuse. A task force is planned to provide training on AHT to professionals in different disciplines on clinical presentation, diagnostic workup, and organization of multidisciplinary evaluation at the hospital and community levels. This study reports on the preliminary findings of the pre-intervention phase of a larger study.Materials and Methods: This is a descriptive, retrospective study exploring the rates of documentation of relevant data in charts, including risk factors for abuse, family demographics, completeness of diagnostic workup, and case finding.Results: Overall, 345 cases were found in hospital databases that were eligible for the retrospective study from 10 participating hospitals. In total, 305 cases (88.4%) were younger than 2 years of age. The most common documented risk factors were low parental education level in 82 families (23.8%), more than three children under 7 years of age in 76 families (22.0%), and bad child temper in 16 families (4.6%), among others. The rate of complete diagnostic workup in hospitals with a multidisciplinary team (MDT) (25.7%) was statistically significantly higher than in hospitals without an MDT (2.9%) (p=0.001). Etiology was identified as inflicted in 78 cases (22.6%), possibly inflicted in 24 (7.0%), undetermined in 79 (22.9%), and accidental in 164 (47.5%) by the researchers, compared to only three cases (0.8%) diagnosed as inflicted by the treating physicians (p<0.0001). In two of the three cases, the perpetrator was convicted; in one, the prosecutor closed the case without a trial on the basis of “no confession” despite the death of the child and medical evidence.Conclusion: Clinicians’ knowledge of the diagnosis of AHT should be increased to improve case finding, which will allow determination of more accurate incidence/ prevalence. This can be accomplished via the establishment of an MDT in teaching hospitals as well as staff training on how to recognize suspicious cases, how to utilize MDT services, and how to report and manage cases on a community level multidisciplinary basis.