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Infant abuse diagnosis associated with abusive head trauma criteria: incidence increase due to overdiagnosis?

Ulf Högberg1, Erik Lampa2, Göran Högberg3

  • 1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

European Journal of Public Health
|April 20, 2018
PubMed

Insights

Infant abuse diagnoses strongly correlate with Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT) criteria. Rising diagnoses may reflect increased awareness of SBS/AHT, not necessarily more abuse cases.

Area of Science:

  • Pediatrics
  • Forensic Medicine
  • Public Health

Background:

  • Infant abuse diagnosis is often linked to Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT) criteria.
  • Increased awareness of SBS/AHT diagnostic criteria may influence infant abuse diagnosis rates.

Purpose of the Study:

  • To investigate the association between infant abuse diagnoses and SBS/AHT criteria.
  • To analyze trends in infant abuse incidence and their potential relation to SBS/AHT awareness.

Main Methods:

  • Population-based register study in Sweden (1987-2014) using national health and death registers.
  • Analysis of over 2.8 million children, identifying infant abuse based on ICD-9/10 codes.
  • Defined SBS/AHT criteria included subdural hemorrhage, cerebral contusion, skull fractures, and retinal hemorrhages.

Main Results:

  • A strong association was found between infant abuse diagnoses and SBS/AHT criteria.
  • Infant abuse diagnoses in Sweden increased tenfold since the 1990s, doubling since 2008.
  • Incidence rates showed regional disparities, with no link to factors like preterm birth or maternal origin.

Conclusions:

  • Infant abuse diagnosis is linked to SBS/AHT criteria, with incidence rising alongside medical preparedness for SBS/AHT diagnosis.
  • While a true increase in abuse is less plausible, the possibility of overdiagnosis due to heightened awareness warrants consideration.
  • The rise in diagnoses raises ethical and medico-legal concerns regarding infant abuse and SBS/AHT evaluations.
Abstract

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