A population-based study of inflicted traumatic brain injury in young children
Heather T Keenan1, Desmond K Runyan, Stephen W Marshall
1Department of Social Medicine, University of North Carolina at Chapel Hill, NC 27599-7240, USA. hkeenan@med.unc.edu
Insights
Physical abuse causes serious head injuries in young children. The study found an incidence of 17.0 per 100,000 person-years for inflicted traumatic brain injury (TBI) in North Carolina children aged 2 years or younger.
Area of Science:
- Pediatric critical care
- Child abuse and neglect
- Traumatic brain injury epidemiology
Background:
- Physical abuse is a primary cause of severe head injuries and fatalities in children under two.
- The exact incidence of inflicted traumatic brain injury (TBI) in U.S. children remains undetermined.
Purpose of the Study:
- To ascertain the incidence of serious or fatal inflicted TBI within a defined U.S. population.
- Focus on children aged two years or younger.
Main Methods:
- Prospective identification of North Carolina children (≤2 years) admitted to PICU or deceased with TBI in 2000-2001.
- Injuries classified as inflicted based on confession or agency determination.
- Multivariate logistic regression used to compare risk factors.
Main Results:
- 152 cases of serious/fatal TBI identified; 80 (53%) were inflicted.
- Incidence of inflicted TBI was 17.0 per 100,000 person-years.
- Higher incidence in infants vs. toddlers, and in boys vs. girls. Increased risk associated with young maternal age, non-European American ethnicity, and multiple births.
Conclusions:
- Inflicted TBI incidence in North Carolina children varies by child and maternal characteristics.
- Findings can inform targeted preventive interventions for child abuse.
Context:
Physical abuse is a leading cause of serious head injury and death in children aged 2 years or younger. The incidence of inflicted traumatic brain injury (TBI) in US children is unknown.
Objective:
To determine the incidence of serious or fatal inflicted TBI in a defined US population of approximately 230 000 children aged 2 years or younger.
Design, Setting, And Subjects:
All North Carolina children aged 2 years or younger who were admitted to a pediatric intensive care unit or who died with a TBI in 2000 and 2001 were identified prospectively. Injuries were considered inflicted if accompanied by a confession or a medical and social service agency determination of abuse.
Main Outcome Measure:
Incidence of inflicted TBI. Multivariate logistic regression models were used to compare children with inflicted injuries with those with noninflicted injuries and with the general state population aged 2 years or younger.
Results:
A total of 152 cases of serious or fatal TBI were identified, with 80 (53%) incurring inflicted TBI. The incidence of inflicted traumatic brain injury in the first 2 years of life was 17.0 (95% confidence interval [CI], 13.3-20.7) per 100 000 person-years. Infants had a higher incidence than children in the second year of life (29.7 [95% CI, 22.9-36.7] vs 3.8 [95% CI, 1.3-6.4] per 100 000 person-years). Boys had a higher incidence than girls (21.0 [95% CI, 15.1-26.6] vs 13.0 [95% CI, 8.4-17.7] per 100 000 person-years). Relative to the general population, children who incurred an increased risk of inflicted injury were born to young mothers (< or =21 years), non-European American, or products of multiple births.
Conclusions:
In this population of North Carolina children, the incidence of inflicted TBI varied by characteristics of the injured children and their mothers. These data may be helpful for informing preventive interventions.
