Transfer of knowledge to diagnose infant abuse and its incidence - a time-series analysis from Sweden
Ulf Högberg1,2
1Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden. ulf.hogberg@kbh.uu.se.
Insights
Knowledge transfer on shaken baby syndrome (SBS/AHT) influenced infant abuse diagnoses. Supportive knowledge increased maltreatment diagnoses, while disruptive knowledge later led to a decline, suggesting potential de-implementation.
Area of Science:
- Pediatrics
- Public Health
- Forensic Medicine
Background:
- Infant abuse, particularly shaken baby syndrome/abusive head trauma (SBS/AHT), poses a significant public health challenge.
- Understanding the dynamics of knowledge transfer is crucial for effective prevention and diagnosis strategies.
Purpose of the Study:
- To analyze the impact of knowledge transfer regarding physical abuse detection, specifically SBS/AHT, on infant abuse diagnosis trends.
- To investigate the association between the dissemination of information on SBS/AHT and changes in maltreatment and assault diagnoses in infants.
Main Methods:
- Retrospective, population-based, and quasi-experimental study design.
- Analysis of infant abuse diagnoses (maltreatment and assault) in Sweden from 1987-2019.
- Literature review to assess knowledge transfer (diffusion, dissemination, implementation) related to SBS/AHT.
Main Results:
- Overall abuse incidence was stable from 1987-2000. Following increased knowledge transfer on SBS/AHT from 2002, maltreatment diagnoses rose significantly until 2013.
- A subsequent increase in disruptive knowledge transfer regarding SBS/AHT between 2014-2019 was associated with a decline in maltreatment diagnoses.
Conclusions:
- Increased maltreatment diagnoses correlated with the transfer of supportive knowledge about the SBS/AHT paradigm.
- A decline in diagnoses towards the study's end suggests a potential de-implementation of certain knowledge or practices related to infant abuse detection.
Aim:
To analyse the transfer of knowledge on how to detect physical abuse, especially shaken baby syndrome/abusive head trauma (SBS/AHT), and its association to trends in infant abuse diagnoses (maltreatment and assault).
Methods:
Design: retrospective population-based and quasi-experimental.
Setting:
Sweden 1987-2019.
Patients:
Children below age 1 year, selected from the National Patient Register (n = 1150). Exposures: Literature search for transfer of knowledge by diffusion, dissemination and implementation, and whether supportive or disruptive of the SBS/AHT paradigm.
Main Outcome Measure:
Abuse diagnoses (maltreatment or assault).
Analyses:
Incidence rate, incidence rate ratio (IRR).
Results:
The overall incidence rate of abuse was 32.23 per 100,000 during the years 1987-2019. It was rather stable 1987-2000. The SBS diagnosis was introduced in the late 1990s. A comprehensive increase of transfer of knowledge on physical abuse, specifically on SBS/AHT and dangers of shaking, took place from 2002 and onward through diffusion, dissemination and implementation. Maltreatment diagnoses, but not assault diagnosis, increased steeply during 2002-2007, peaking in 2008-2013 [IRR 1.63 (95% confidence interval 1.34-1.98)]. Transfer of disruptive knowledge on SBS/AHT during the period 2014-2019 was associated with a decline in maltreatment diagnoses [IRR 0.84 (95% confidence interval 0.71-0.99)].
Conclusion:
An increase in maltreatment diagnoses was associated with transfer of supportive knowledge of the SBS/AHT paradigm, while a decline occurred toward the end of the study period, which might indicate a burgeoning de-implementation process.
