Defining paediatric abusive head trauma using routinely collected patient datasets: Definition development for a UK
Joni Jackson1, Lauren J Scott1, Sarah Dawson1
1The National Institute for Health and Care Research Applied Health Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Whitefriars, Bristol, BS1 2NT, UK.
Insights
New definitions for abusive head trauma (AHT) capture more cases presenting to primary care, leading to more accurate population incidence estimates. This improves identification of AHT in infants across UK healthcare settings.
Area of Science:
- Pediatric medicine
- Public health surveillance
- Medical informatics
Background:
- Existing definitions for abusive head trauma (AHT) are primarily designed for secondary care or mortality data.
- Current definitions underestimate AHT incidence by excluding mildly symptomatic cases presenting to primary care.
Purpose of the Study:
- To develop AHT definitions applicable to UK primary care, secondary care, and accident and emergency data.
- To compare AHT incidence in a UK primary care cohort using the newly developed definitions.
Main Methods:
- Clinical expert consensus was used to develop AHT definitions incorporating traumatic brain injury, abuse, and head CT scan codes.
- A UK primary care cohort (infants <1 year, Jan 2013-June 2021) was analyzed using linked electronic health records (CPRD Aurum, HES APC, HES AE, DID).
Main Results:
- New AHT definitions were created using combinations of specific diagnostic and procedural codes in UK health records.
- Definitions including general practice, hospital, and emergency department presentations identified a higher incidence of AHT compared to existing literature-based ICD-10 definitions.
Conclusions:
- The developed definitions, encompassing presentations to general practitioners, emergency departments, and hospital admissions, likely yield more accurate population incidence estimates for AHT.
- Potential for false positives and missed cases due to non-presentation to healthcare necessitates caution when interpreting results.
Background:
Existing definitions used to identify abusive head trauma (AHT) from routinely collected patient data are developed for use in secondary care or mortality data. Incidence estimates calculated using these definitions do not include mildly symptomatic cases of AHT presenting to primary care, therefore underestimating the true population incidence.
Objective:
To (1) develop AHT definitions for use with primary care, secondary care and accident and emergency data in the UK setting; (2) compare incidence using these definitions in a UK primary care cohort.
Participants And Setting:
The cohort included all infants in Clinical Practice Research Database (CPRD) Aurum, under 1 year old between January 2013 and June 2021, with linkages to Hospital Episodes Statistics Admitted Patient Care (HES APC), Accident and Emergency (HES AE) data and Diagnostic Imaging Dataset (DID).
Method:
This study had two parts, (1) definition development via clinical expert consensus, and (2) comparative testing of definitions in a UK primary care cohort.
Results:
Definitions of AHT were developed based on combinations of traumatic brain injury, abuse and head computerised tomography codes present in UK health records. Our definitions for AHT presenting to general practice, hospital and ED identified higher incidence in our cohort than all ICD-10 based definitions identified in the literature.
Conclusion:
Inclusion of injuries presenting to GP, ED or admitted to hospital, in our definitions is likely to produce a more accurate estimate of AHT in the population. Caution should be applied, however, regarding potential inclusion of false positives and missed cases due to non-presentation to healthcare.
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