Retention in a longitudinal multidisciplinary abusive head trauma clinic.

BACKGROUND

Many children who experience abusive head trauma (AHT) have long-term, multidisciplinary healthcare needs. However, little is known about longitudinal follow-up or characteristics associated with medical retention. Prior longitudinal studies of outcomes have been hampered by low retention, raising questions about barriers to follow-up after the diagnosis of AHT. In order to facilitate follow-up care, we created a comprehensive, multidisciplinary clinic for children with AHT.

OBJECTIVE

Describe patient retention in a multidisciplinary clinic for children with AHT and examine associations between injury characteristics and child placement outcomes with retention metrics.

PARTICIPANTS AND

SETTING

Data were abstracted from the medical charts of all children diagnosed with AHT from 6/1/2011 to 12/31/2020 at a single center and referred to a dedicated follow-up AHT clinic (Non-Accidental Brain Injury Care Clinic; NABICC).

METHOD: We calculated the number of follow-up visits over 24 months. We used multivariable regression to determine the association between demographics, injury characteristics, and child placement outcomes with clinic retention.

RESULTS

Over the study period, 407 patients were diagnosed with AHT and 365 (90%) children survived to hospital discharge. Eighty percent attended at least one NABICC follow-up visit, with an average of 4.5 visits over 24 months. In univariate analysis, parenchymal injuries, retinal hemorrhage, increasing PICU days, and removal from the home were statistically correlated with increased number of follow-up visits. In multivariable regression analyses, subdural hemorrhage, parenchymal injuries, PICU days, and out-of-home placement were all significantly associated with increased visits. Younger children had more visits compared to older children (≥ 24 months).

CONCLUSION

Retention was high in this longitudinal, multi-disciplinary AHT clinic. Retention is associated with severe injury and out-of-home placement. This model of care has potential to advance clinical care and outcomes research.