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Abusive head trauma in young children: a population-based study
Anbesaw W Selassie1, Keith Borg, Carrie Busch
1From the Divisions of *Epidemiology and Biostatistics and †Emergency Medicine and Pediatric Emergency Medicine, Department of Medicine; and Divisions of ‡Pediatric Emergency Medicine and Violence Intervention and Prevention and §Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Insights
Abusive head trauma (AHT) incidence in children under 5 is underestimated without emergency department data. Intracranial bleeding is a key indicator for identifying AHT cases and improving surveillance.
Area of Science:
- Pediatrics
- Public Health
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a significant cause of injury in young children.
- Accurate incidence data is crucial for effective public health surveillance and prevention efforts.
Purpose of the Study:
- To determine the population-based incidence of AHT in children aged 0-5 years.
- To identify risk factors associated with AHT for improved case recognition.
- To enhance public health surveillance strategies for abusive head trauma.
Main Methods:
- Retrospective cohort study of children aged 0-5 with head trauma (HT) encounters.
- Inclusion of both inpatient and emergency department (ED) data from 2000-2010.
- Cox hazards regression and Kaplan-Meier analysis to assess risk and incidence.
Main Results:
- Out of 26,681 children with HT, 502 (1.8%) were classified as AHT.
- AHT incidence was highest in infants (28.9/100,000) and decreased with age.
- Intracranial bleeding (HR 20.3) and retinal hemorrhage (HR 11.4) were strongly associated with AHT.
Conclusions:
- Emergency department data are essential for complete AHT incidence estimates.
- Intracranial bleeding is a critical clinical marker for identifying AHT.
- Improved case ascertainment through recognizing key clinical features can enhance AHT surveillance.
Objective:
The objectives of this study were to provide population-based incidence estimate of abusive head trauma (AHT) in children aged 0 to 5 years from inpatient and emergency department (ED) and identify risk characteristics for recognizing high-risk children to improve public health surveillance.
Methods:
This was a retrospective cohort study based on children's first encounter in ED or hospital admission with a diagnosis of head trauma (HT), 2000-2010. The relationship between clinical markers and AHT was examined controlling for covariables in the model using Cox hazards regression. Kaplan-Meier incidence probability was plotted, and the number of weeks elapsing from date of birth to the first encounter with HT established the survival time (T).
Results:
Twenty-six thousand six hundred eighty-one children had HT, 502 (1.8%) resulted from abuse; 42.4% was captured from ED. Incidence varied from 28.9 (95% confidence interval [CI], 27.9-37.4) in infants to 4.1 (95% CI, 2.4-5.7) in 5-year-olds per 100,000 per year. Adjusted hazard ratio was 20.3 (95% CI, 10.9-38.0) for intracranial bleeding and 11.4 (95% CI, 8.57-15.21) for retinal hemorrhage.
Conclusions:
Incidence estimates of AHT are incomplete without including ED. Intracranial bleeding is a cardinal feature of AHT to be considered in case ascertainment to improve public health surveillance.
