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Paediatric patients with abusive head trauma treated in US Emergency Departments, 2006-2009
Joe Xiang1, Junxin Shi, Krista Kurz Wheeler
1Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital , Columbus, OH , USA .
Insights
Abusive head trauma (AHT) affects thousands of young children annually, with infants under one year being most vulnerable. Accurate documentation and caregiver education are vital to reduce AHT incidence and mortality.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Child Abuse Research
Background:
- Abusive head trauma (AHT) is a significant cause of severe injury and mortality in infants and young children.
- Understanding the characteristics and outcomes of AHT is crucial for developing effective prevention and intervention strategies.
Purpose of the Study:
- To characterize pediatric patients with abusive head trauma (AHT) treated in emergency departments.
- To compare outcomes between AHT and non-AHT patients.
- To identify risk factors associated with AHT.
Main Methods:
- Analysis of Nationwide Emergency Department Sample (NEDS) data from 2006-2009.
- Classification of children ≤ 4 years with head trauma into AHT and non-AHT groups using CDC criteria.
- Logistic regression models to identify risk factors for AHT.
Main Results:
- An estimated 10,773 pediatric AHT cases occurred during the study period, with an annual rate of 12.83 per 100,000 children ≤ 4 years.
- Infants < 1 year accounted for 60.6% of AHT cases; males had a higher incidence than females.
- The case mortality rate for AHT was significantly higher (53.9 per 1000) compared to non-AHT (1.6 per 1000).
Conclusions:
- Educating child caregivers on infant care and the dangers of AHT is essential.
- Accurate and unbiased medical documentation of AHT is critical for surveillance and understanding injury patterns.
Objective:
To study characteristics and outcomes of paediatric patients with abusive head trauma (AHT) treated in emergency departments.
Methods:
Nationwide Emergency Department Sample (NEDS) data were analysed. The CDC recommended AHT definition was used to classify children ≤ 4 years with head trauma into AHT and non-AHT groups. Outcomes were compared between patients with AHT and patients with non-AHT. Logistic models were fitted to identify risk factors.
Results:
An estimated 10 773 paediatric patients with AHT were treated in EDs in 2006-2009. The average annual rate was 12.83 per 100 000 for children ≤ 4 years. Children < 1 year of age accounted for most AHT cases (60.6%) and males had a significantly higher AHT rate than females. Medicaid was the primary payer for 66.1% of AHT injuries and 40.3% of non-AHT injuries. The case mortality rate was 53.9 (95% CI = 41.0-66.7) per 1000 patients with AHT compared with 1.6 (95% CI = 1.4-1.9) per 1000 patients with non-AHT.
Conclusions:
Child caregivers should be educated about the serious consequences of AHT and proper techniques for caring for infants. Unbiased and accurate documentation of AHT by physicians and medical coders is crucial for monitoring AHT injuries.
