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Fractures and traumatic brain injuries: abuse versus accidents in a US database of hospitalized children
John M Leventhal1, Kimberly D Martin, Andrea G Asnes
1Yale University School of Medicine, Department of Pediatrics, New Haven, CT 06520-8064, USA. john.leventhal@yale.edu
Insights
Abusive traumatic brain injuries (TBIs) and fractures are a concern in young children. While falls are more common, abuse accounts for significant injury rates, especially in infants under 12 months.
Area of Science:
- Pediatric Traumatology
- Child Abuse and Neglect
- Public Health Surveillance
Background:
- Traumatic brain injuries (TBIs) and fractures are significant concerns in young children.
- Distinguishing between abusive injuries and accidental trauma is crucial for timely intervention.
Purpose of the Study:
- To determine the incidence of abusive traumatic brain injuries (TBIs) and/or fractures in children under 36 months of age.
- To compare the frequency of abuse versus accidental causes for these injuries.
Main Methods:
- Utilized the 2006 Kids' Inpatient Database for injury classification.
- Categorized injuries into TBI only, TBI and fracture, or fracture only.
- Compared abuse, accidental falls, other accidents, and motor vehicle accidents for each injury type and pattern.
Main Results:
- Abusive TBIs and/or fractures occurred in 21.9 per 100,000 children <36 months, and 50.0 per 100,000 children <12 months.
- In abusive injuries, 41.8% were fractures only, 29.9% TBI only, and 28.3% TBI and fractures.
- Accidental falls were more common than abuse for TBI only in the first 2 months and for TBI and skull fracture in the first year.
Conclusions:
- There is overlap between TBIs and fractures attributable to abuse.
- Abusive TBIs and/or fractures occurred in 1 in 2000 children under 12 months.
- Accidental falls were more frequent than abuse, even in very young children.
Objective:
The goal was to use a national database to determine the incidence of abusive traumatic brain injuries (TBIs) and/or fractures and the frequency of abuse versus accidents among children <36 months of age.
Methods:
We used the 2006 Kids' Inpatient Database and classified cases into 3 types of injuries, that is, (1) TBI only, (2) TBI and fracture, or (3) fracture only. Groups 2 and 3 were divided into 3 patterns, that is, (1) skull fractures, (2) skull and nonskull fractures, or (3) nonskull fractures. For each type and pattern, we compared abuse, accidental falls, other accidents, and motor vehicle accidents.
Results:
The incidence of TBIs and/or fractures attributable to abuse was 21.9 cases per 100,000 children <36 months of age and 50.0 cases per 100,000 children <12 months of age. In the abuse group, 29.9% of children had TBIs only, 28.3% TBIs and fractures, and 41.8% fractures only. Abused children were younger and were more likely to be enrolled in Medicaid. For TBI only, falls were more common than abuse in the first 2 months of life but abuse was more common from 2 to 7 months. For TBI and skull fracture, falls were more common during the first year of life. For skull fracture only, almost all injuries were attributable to falls.
Conclusions:
There was overlap in TBIs and fractures attributable to abuse. Among <12-month-old children, TBIs and/or fractures attributable to abuse occurred in 1 of 2000. Falls occurred more commonly than abuse, even among very young children.
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