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Defining paediatric abusive head trauma using routinely collected patient datasets: Scoping review and testing in a
Joni Jackson1, Lauren J Scott1, Sarah Dawson1
1The National Institute for Health Research Applied Health and Care 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
Identifying abusive head trauma (AHT) is challenging due to poor coding. This study found wide incidence variations in UK primary care data, highlighting the need for standardized definitions to improve AHT case identification.
Area of Science:
- Pediatrics
- Public Health
- Data Science
Background:
- Abusive head trauma (AHT) is underreported and poorly coded in patient data, hindering identification, especially in non-hospitalized cases.
- Existing AHT definitions primarily rely on hospital data and may not be suitable for routine primary care settings.
Purpose of the Study:
- To identify definitions of AHT used in routine patient data.
- To compare the impact of different AHT definitions on incidence estimates within a UK primary care cohort.
Main Methods:
- A scoping review identified 29 AHT definitions from 40 studies, primarily using hospital-based ICD codes.
- These definitions were applied to a UK primary care cohort (infants under 1 year, 2013-2021) linked to secondary care and A&E data.
- Incidence rates were calculated per 100,000 person-years to assess variability.
Main Results:
- Most identified AHT definitions were based on hospital data (ICD-9-CM, ICD-10) and not validated for UK primary care.
- Applying these definitions to the UK primary care cohort yielded incidence estimates ranging from 9-15 per 100,000 person-years for "probable" or "presumptive" AHT.
- Broader definitions, including "possible" AHT, resulted in higher incidence estimates, up to 49 per 100,000 person-years.
Conclusions:
- The significant variability in AHT incidence estimates underscores the inadequacy of current definitions for UK primary care datasets.
- A standardized AHT definition tailored for UK primary care data is crucial for accurate case identification and epidemiological studies.
Background:
Suboptimal coding and underreporting of abusive head trauma (AHT) makes cases difficult to identify from routinely collected patient data, particularly if not admitted to hospital.
Objective:
To identify existing AHT definitions for routine patient data and compare their impact on AHT incidence estimates when applied to a UK primary care cohort.
Participants And Setting:
Cohort participants were all infants in a large primary care database, who were under 1 year old between January 2013 and June 2021, registered at a General Practice, with linkages to secondary care and Accident and Emergency data.
Method:
A scoping review to identify studies that used diagnostic codes or routinely collected data to define AHT in children under 5 years from electronic health records. We used the definitions identified to calculate incidence per 100,000 person-years in a UK primary care cohort to explore variability of incidence estimates.
Results:
We identified 40 eligible studies (29 definitions), with most definitions based on hospital data using ICD-9-CM and ICD-10 codes. None applied to a UK population or primary care data sources. Incidence of AHT in our cohort ranged from 9 to 15 per 100,000 person-years using "probable" or "presumptive" definitions, and up to 49 per 100,000 person-years using broader definitions including "possible" AHT.
Conclusion:
The wide range of hospital AHT incidence calculated in our cohort using the definitions identified in the scoping review indicates a need for a standardised definition suited to UK datasets including primary care.
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