Simulation of the Impact of Programs for Prevention and Screening of Pediatric Abusive Head Trauma
Marion Bailhache1,2, Antoine Bénard2,3,4, Louis-Rachid Salmi2,3
11 CHU de Bordeaux, Pole de pediatrie, Service d'information medicale , Bordeaux, France .
Insights
Primary prevention programs effectively reduce pediatric abusive head trauma (PAHT) deaths. However, screening programs carry uncertain outcomes, potentially causing harm due to mislabeling parents, highlighting the need for careful implementation.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Pediatric abusive head trauma (PAHT) prevention strategies are crucial.
- Early screening for PAHT is proposed, but potential negative impacts, such as mislabeling parents, are not well-documented.
Purpose of the Study:
- To simulate the impact of primary prevention and screening programs for PAHT.
- To evaluate the effectiveness and potential harms of PAHT interventions in a high-income country.
Main Methods:
- Development of Markov models to simulate life histories of PAHT.
- Modeling scenarios included no intervention, primary prevention only, screening only, and combined programs.
- Analysis of outcomes such as deaths and abused children avoided over a 2-year period.
Main Results:
- Primary prevention programs showed a median of 6-28 deaths avoided per 100,000 newborns.
- Screening programs had uncertain outcomes, potentially preventing up to 6 or causing up to 66 deaths per 100,000 children.
- The combined impact of both programs remained uncertain.
Conclusions:
- Primary prevention programs for PAHT demonstrate clear potential benefits.
- Screening programs for PAHT present significant uncertainties and potential risks that require further investigation.
- Careful consideration of potential harms, like false accusations, is essential when implementing PAHT interventions.
Abstract:
Primary prevention programs of pediatric abusive head trauma (PAHT) exist and early screening is proposed, but negative effects of mislabeling parents as abusers, an important issue, are not well documented. The aim of our study was to simulate the possible impact of programs for the primary prevention and screening of PAHT. We developed Markov models that simulate the life histories of PAHT with no intervention, with primary prevention program only, with screening program, and with both programs in a hypothetical cohort of 800,000 newborns in a high-income country. Screening program would be addressed to all families until children are 2 years old, during repeated consultations. Potential side effects for parents being mislabeled as abusers were supposed to increase the probability of PAHT and decrease participation in screening. Time horizon was 2 years with cycles of 15 days. Outcomes were number of deaths and abused children avoided. Uncertainty was specified with probability distributions. After 2 years, the median number of deaths avoided through primary prevention would vary from 6 (95% confidence interval [CI] 2-11) to 28 (95% CI 6-51) per 100,000 newborns. Screening could prevent up to 6 (95% CI 0-29) or cause up to 66 (95% CI 0-361) deaths per 100,000 children born alive. The impact of both programs was uncertain. Our model confirmed the potential benefits of primary prevention and documented the uncertainty associated with screening of PAHT.
