Differences in Incidence and Case Fatality of Abusive Head Trauma

Abusive head trauma (AHT) in children older than 1 and younger than 5 years old is thought uncommon and rarely studied.

This study estimates national incidence and case fatality rate of abusive head trauma (AHT), and evaluates differences by age, sex, race, and region, with a focus on children of 2-4 years.

Hospital discharges were extracted from The Healthcare Cost and Utilization Project's Kids' Inpatient Database from 2000, 2003, 2006, 2009, and 2012 using the CDC's narrow definition of AHT.

Survey-weighted chi-square tests were used to assess differences in incidence and case fatality rates.

The average annual incidence per 100,000 children was highest in <1 year-olds (27), followed by age 1 (4), age 2 (3), and age 3-4 (1). Average annual incidence varied significantly by sex (p = 0.0001), race (p < 0.0001), and region (p = 0.0002) within each age category. The average annual case fatality rate increased significantly with age, with a rate of 0.10 among children age <1 year, 0.15 for age 1, 0.23 for age 2, and 0.20 for age 3-4 years. The average annual case fatality rate was higher in the South (0.12) than West (0.10), Midwest (0.09), and Northeast (0.08) among children <1 year of age.

Black and Hispanic children and hospitals in the Midwest experienced higher incidence of AHT than White children and Northeast hospitals, respectively, especially in cases <1 year of age. Case fatality rates increased significantly with age, and the South experienced the highest rates for infants <1 year.