Clinical prognosis and neurosurgical management of abusive head trauma: a scoping review

OBJECTIVE This scoping review sought to synthesize the current evidence for prognosis and neurosurgical management in abusive head trauma (AHT), a particularly deadly form of pediatric traumatic brain injury (TBI). METHODS Using key search terms such as "abusive head trauma," "neurosurgical procedures," "mortality," and "prognosis," the authors imported articles published between 2009 and 2025 from PubMed, EMBASE, Web of Science, and CINAHL, as well as from citation and gray literature searches of Covidence. Duplicates were removed (n = 3138), and after abstract and full-text screening, 46 articles remained for data extraction. Although these articles addressed more than one category, each was classified according to the primary focus and/or substantive data presented. RESULTS The included studies examined the relative prognosis of AHT relative to accidental trauma (AT) (n = 10 articles), clinical (n = 16) and demographic (n = 8) prognostic factors in AHT, and neurosurgical management of AHT (n = 12). Compared to AT, AHT was consistently associated with greater mortality, longer and more intensive hospitalizations, as well as higher risks of short- and long-term multisystem dysfunction. Among AHT patients, low admission Glasgow Coma Scale scores, abnormal neuroimaging findings, seizures, retinal hemorrhage, respiratory compromise, and abnormal pupillary reactivity were associated with increased morbidity and mortality. Older age at injury and lower socioeconomic status were also associated with poor outcomes in AHT. Rates of neurosurgical intervention varied widely, with particularly high reoperation rates in those who underwent transfontanelle aspiration for subdural fluid collections. CONCLUSIONS This scoping review highlights the particularly poor prognosis of AHT, underscoring the potential utility of the identified clinical and demographic prognostic factors in guiding closer clinical management or earlier surgical intervention.