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Do data from child protective services and the police enhance modelling of perinatal risk for paediatric abusive head
Patrick Kelly1,2, John M D Thompson3, Santuri Rungan4
1Te Puaruruhau, Starship Children's Health, Auckland, New Zealand.
Insights
Families known to child protective services or police face a higher risk of abusive head trauma (AHT). However, this information offers minimal improvement to predictive models using standard health records for AHT risk assessment.
Area of Science:
- Pediatrics
- Public Health
- Forensic Medicine
Background:
- Abusive head trauma (AHT), previously known as shaken baby syndrome, is a significant cause of pediatric injury.
- Identifying risk factors for AHT is crucial for early intervention and prevention strategies.
Purpose of the Study:
- To determine if a family's history with child protective services (CPS) or police at birth correlates with an increased risk of AHT.
- To assess whether CPS or police data enhances the predictive accuracy of risk models for AHT based on health records.
Main Methods:
- A retrospective case-control study was conducted.
- Data from CPS and police records were analyzed for 142 AHT cases and 550 matched controls across nine maternity hospitals.
Main Results:
- Families known to CPS or police showed a significantly higher risk of AHT.
- In multivariable analysis incorporating perinatal health data, CPS notification was the only significant predictor (OR 4.84).
- Adding CPS notification to health data marginally improved the predictive model's performance (AUC 90.9% vs. 89.5%).
Conclusions:
- Family involvement with CPS or police is linked to a greater risk of AHT.
- While associated with risk, CPS or police involvement data provides limited additional predictive value when integrated into existing health record-based risk models for AHT.
Objectives:
First, to investigate whether there is a relationship between a family being known to child protective services or police at the time of birth and the risk of abusive head trauma (AHT, formerly known as shaken baby syndrome). Second, to investigate whether data from child protective services or police improve a predictive risk model derived from health records.
Design:
Retrospective case control study of child protective service and police records.
Setting:
Nine maternity hospitals.
Participants:
142 consecutive cases of AHT admitted to a tertiary children's hospital from 1991 to 2010 and born in one of the nine participating maternity hospitals. 550 controls matched by the date and hospital of birth.
Outcome Measure:
Abusive head trauma.
Results:
There is a relationship between families known to child protective services or police and the risk of AHT. Notification to child protective services: univariable OR 7.24 (95% CI 4.70 to 11.14). Involvement with youth justice: univariable OR 8.94 (95% CI 4.71 to 16.95). Police call-out for partner violence: univariable OR 3.85 (95% CI 2.51 to 5.91). Other violence offence: univariable OR 2.73 (95% CI 1.69 to 4.40). Drug offence: univariable OR 2.82 (95% CI 1.63 to 4.89). However, in multi-variable analysis with data from perinatal health records, notification to child protective services was the only one of these variables to remain in the final model (OR 4.84; 95% CI 2.61 to 8.97) and had little effect on overall predictive power. The area under the receiver operating characteristic curve was 89.5% (95% CI 86.6 to 92.5) using variables from health data alone and 90.9% (95% CI 88.0 to 93.7) when notification was added.
Conclusions:
Family involvement with child protective services or police is associated with increased risk of AHT. However, accessing such data at the time of birth would add little predictive power to a risk model derived from routine health information.
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