Abusive head trauma: an epidemiological and cost analysis

Area of Science:

• Pediatric Medicine
• Public Health
• Forensic Pathology

Background:

• Pediatric abusive head trauma (AHT) research often centers on clinical aspects.
• A public health perspective is needed to understand local AHT demographics and trends.
• This study reviews a single institution's experience with AHT.

Purpose of the Study:

• To understand the local population affected by AHT.
• To determine AHT incidence and seasonal trends.
• To detail hospitalization, injuries, interventions, and costs for AHT cases.

Main Methods:

• Reviewed 213 AHT cases at Le Bonheur Children's Hospital (2009-2014).
• Defined AHT as skull fracture or intracranial hemorrhage in children under 5 with suspicious mechanisms or other intentional injuries.
• Categorized injuries into Grade I (fracture only), Grade II (non-surgical hemorrhage/edema), and Grade III (surgical intervention or death).

Main Results:

• AHT victims were predominantly infants (55% ≤6 months), male (61%), African American (47%), and publicly insured (82%).
• Annual AHT incidence increased from 19.6 to 47.4 per 100,000 children under 5.
• Total hospital charges exceeded $13 million; Grade III injuries incurred costs up to 10 times higher than less severe cases.

Conclusions:

• AHT disproportionately affects infants, males, and those from lower socioeconomic backgrounds.
• AHT incidence is rising, with substantial and variable hospitalization costs.
• A 3-tiered injury classification effectively stratifies hospital stay length and cost.