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Cain CM, Mandell DJ, Thompson RR, Cummings AL, Van Horne BS, Greeley CS. Trends in Abusive and Nonabusive Injury Hospitalizations in Young Children in Texas, 2004-2018. CHILD MALTREATMENT 2022; 27:246-256. [PMID: 33291969 DOI: 10.1177/1077559520979572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hospitalization data provide context to understanding abusive and non-abusive injuries and how these hospitalizations change over time. The purpose of this study was to utilize Texas inpatient hospitalization data to assess age-related differences among infants (<12 months of age) and toddlers (12-59 months of age) in injury trends and patterns of injury among abusive and non-abusive hospitalization encounters over a 15-year time period. For both age groups, pediatric hospitalizations for non-abusive injuries decreased significantly over time; however, hospitalizations for abusive injuries did not. Compared to non-abusive injury hospitalizations, abusive injury hospitalizations were statistically more likely to involve more body regions and were associated with fractures, internal organ injuries, and superficial wounds. Abusive injury hospitalizations had longer lengths of stay and resulted in higher illness severity scores. Toddler injury hospitalizations were associated with most of the body regions, with the exception of traumatic brain injury for which the odds of hospitalization were higher for infants. This study confirms the persistence of abusive injury hospitalizations and the age-related susceptibility to certain injuries comparing infants and toddlers. The findings reflect the clinical documentation and decision making of pediatric practitioners in a large state over 15 years and inform the trends in identification of injuries which are most common and consistent by age and intent.
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Affiliation(s)
- Cary M Cain
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Dorothy J Mandell
- Population Health, The University of Texas Health Science Center at Tyler, TX, USA
| | - Ralph R Thompson
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Angela L Cummings
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Bethanie S Van Horne
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Christopher S Greeley
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
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Wilson TA, Gospodarev V, Hendrix S, Minasian T. Pediatric abusive head trauma: ThinkFirst national injury prevention foundation. Surg Neurol Int 2021; 12:526. [PMID: 34754576 PMCID: PMC8571401 DOI: 10.25259/sni_194_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Pediatric abusive head trauma (AHT) represents 80% of nonaccidental trauma deaths, remaining a lead cause of death among infants and young children. Furthermore, neurosurgical intervention can ameliorate damage from secondary injury, but we are currently unable to alter the impact of the primary injury. Thus, prevention through increased public awareness is imperative. This study identifies injuries and predictors of outcomes in pediatric AHT and highlights the importance of partnering with our community through ThinkFirst, a national injury prevention foundation, to educate parents and caregivers about prevention. Methods: This single-institution retrospective review identifies injuries and predictors of outcomes in pediatric AHT and highlights the importance of partnering with our community to raise awareness and educate parents and caregivers about prevention. Results: The number of pediatric AHT cases continues to steadily increase over time (P < 0.001), and over 70% of these patients are <1 year of age (P < 0.001). Patients suffering AHT have a mortality rate of nearly 10%. In addition to morbidity and mortality, the economic burden of caring for abused children is high as they often require high levels of care, long hospital stays, and extensive rehabilitation. Furthermore, Medicaid pays for nearly 80% of these patients. Conclusion: The population of patients with AHT is unique, and one that will benefit from continued efforts at increased multidisciplinary and public awareness. Prevention of AHT through awareness is critical. Through partnering with ThinkFirst, a national injury prevention foundation, we aim to educate parents and caregivers about prevention.
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Affiliation(s)
- Taylor Anne Wilson
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
| | - Vadim Gospodarev
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
| | - Sean Hendrix
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
| | - Tanya Minasian
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
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Soares AP, d'Affonseca SM, Brino RDF. Trauma Craniano Violento (TCV): Relação entre Conhecimento de Pais, Potencial de Abuso Infantil e Status Socioeconômico Familiar. PSICOLOGIA: TEORIA E PESQUISA 2021. [DOI: 10.1590/0102.3772e37315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumo Descreve a relação entre conhecimento sobre Trauma Craniano Violento (TCV), status socioeconômico e potencial de maus-tratos infantis. Dezenove pais e 61 mães responderam aos instrumentos Escala de Atitudes Frente ao Choro do Bebê, Inventário de Potencial de Abuso Infantil e Questionário Socioeconômico. A correlação de Spearman demonstrou resultados significativos entre escolaridade e renda com crenças sobre cuidados com o bebê (r = 0,32, p = 0,004; r = 0,22, p = 0,05, respectivamente), poder aquisitivo e escolaridade com conhecimentos sobre choro infantil (r = -0,40, p<0,001; r = -0,22, p = 0,05, respectivamente), número de filhos com estratégias para lidar com choro (r = -0,29, p = 0,01) e rigidez com consequências de sacudir o bebê e crenças sobre cuidados com o bebê (r = -0,29, p = 0,008; r = -0,359, p = 0,001, respectivamente). Considera importante direcionar intervenções às necessidades de cada população e trabalhar a flexibilidade parental para reduzir o TCV.
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Chang YT, Chang HY, Chen LW, Lu TH, Tsai HJ, Chen YW, Chang YC, Feng JY. Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006-2015: a nationwide population-based study. Inj Prev 2020; 27:356-362. [PMID: 32788223 DOI: 10.1136/injuryprev-2020-043805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan. METHODS The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time. RESULTS From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1-2 (1.7/100 000 and 2.1/100 000) and 3-5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1-5 years. CONCLUSIONS This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession's sensitivity and competence for the early identification and diagnosis of PAHT is critical.
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Affiliation(s)
- Yi-Ting Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Yi Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yi-Wen Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chun Chang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Ying Feng
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan .,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Wright JN, Shaw DWW, Ishak G, Doherty D, Perez F. Cerebellar Watershed Injury in Children. AJNR Am J Neuroradiol 2020; 41:923-928. [PMID: 32327437 DOI: 10.3174/ajnr.a6532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Focal signal abnormalities at the depth of the cerebellar fissures in children have recently been reported to represent a novel pattern of bottom-of-fissure dysplasia. We describe a series of patients with a similar distribution and appearance of cerebellar signal abnormality attributable to watershed injury. MATERIALS AND METHODS Twenty-three children with MR imaging findings of focal T2 prolongation in the cerebellar gray matter and immediate subjacent white matter at the depth of the fissures were included. MR imaging examinations were qualitatively analyzed for the characteristics and distribution of signal abnormality within posterior fossa structures, the presence and distribution of volume loss, the presence of abnormal contrast enhancement, and the presence and pattern of supratentorial injury. RESULTS T2 prolongation was observed at the depths of the cerebellar fissures bilaterally in all 23 patients, centered at the expected location of the deep cerebellar vascular borderzone. Diffusion restriction was associated with MR imaging performed during acute injury in 13/16 patients. Five of 23 patients had prior imaging, all demonstrating a normal cerebellum. The etiology of injury was hypoxic-ischemic injury in 17/23 patients, posterior reversible encephalopathy syndrome in 3/23 patients, and indeterminate in 3/23 patients. Twenty of 23 patients demonstrated an associated classic parasagittal watershed pattern of supratentorial cortical injury. Injury in the chronic phase was associated with relatively preserved gray matter volume in 8/15 patients, closely matching the published appearance of bottom-of-fissure dysplasia. CONCLUSIONS In a series of patients with findings similar in appearance to the recently described bottom-of-fissure dysplasia, we have demonstrated a stereotyped pattern of injury attributable to cerebellar watershed injury.
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Affiliation(s)
- J N Wright
- From the Departments of Radiology (J.N.W., D.W.W.S., G.I., F.P.)
| | - D W W Shaw
- From the Departments of Radiology (J.N.W., D.W.W.S., G.I., F.P.)
| | - G Ishak
- From the Departments of Radiology (J.N.W., D.W.W.S., G.I., F.P.)
| | - D Doherty
- Pediatrics (D.D.), Divisions of Developmental and Genetic Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - F Perez
- From the Departments of Radiology (J.N.W., D.W.W.S., G.I., F.P.)
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Mason SM, Schnitzer PG, Danilack VA, Elston B, Savitz DA. Risk factors for maltreatment-related infant hospitalizations in New York City, 1995-2004. Ann Epidemiol 2018; 28:590-596. [PMID: 30153909 PMCID: PMC6117827 DOI: 10.1016/j.annepidem.2018.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Child maltreatment is a major public health problem, but population-based surveillance and research is hindered by limitations of official child welfare data. The present study used a promising complementary data source, hospital discharge data, to investigate risk factors for infant injuries suggestive of maltreatment. METHODS Discharge data from all hospital births to New York City residents from 1995 to 2004 were linked to birth certificates and to subsequent infant hospitalizations within 12 months after delivery. Probable maltreatment of infants was identified with 33 injury diagnosis codes highly correlated with maltreatment. Modified Poisson regression estimated the association of sociodemographic factors and pregnancy/birth characteristics with subsequent infant admission for probable maltreatment. RESULTS Risk factors for maltreatment included neonatal intensive care unit stays of more than 11 days (adjusted risk ratio [aRR] = 1.8; 95% confidence interval [CI]: 1.1-2.8), preterm birth (aRR = 1.6; 95% CI: 1.2-2.1), maternal age less than 20 years (aRR = 1.5; 95% CI: 1.2-1.9), and public insurance (aRR = 1.5; 95% CI: 1.2-1.9). Factors associated with reduced maltreatment risk included mother born outside the United States (aRR = 0.7; 95% CI: 0.6-0.8) and female infant (aRR = 0.7; 95% CI: 0.6-0.9). CONCLUSIONS Sociodemographic factors and challenges at birth (preterm, neonatal intensive care unit stays) are important risk factors for subsequent maltreatment-related hospitalization, with potential implications for prevention targeting.
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Affiliation(s)
- Susan M Mason
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis.
| | | | - Valery A Danilack
- Department of Epidemiology, Brown University School of Public Health, Providence, RI; Division of Research, Women & Infants Hospital, Providence, RI; Department of Obstetrics and Gynecology, Brown University Alpert Medical School, Providence, RI
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI; Department of Obstetrics and Gynecology, Brown University Alpert Medical School, Providence, RI
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Duzinski SV, Guevara LM, Barczyk AN, Garcia NM, Cassel JL, Lawson KA. Effectiveness of a Pediatric Abusive Head Trauma Prevention Program Among Spanish-Speaking Mothers. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:5-10. [PMID: 29460638 DOI: 10.1177/1540415318756859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study aimed to evaluate participants' knowledge of and intent to share key messages of the Period of PURPLE Crying abusive head trauma prevention program among a majority Spanish-speaking population. METHODS This study was a retrospective review of a postintervention survey administered in the perinatal unit of a community birthing hospital. Surveys were administered to mothers of newborns by perinatal nurses as part of routine process evaluation prior to hospital discharge between May 30, 2014, and May 15, 2015. RESULTS A majority of participants (86.4%) answered all six knowledge questions correctly. Among participants who reported that the father or significant other was not present during the PURPLE education (44.1%), all (100%) reported intending to share the PURPLE information with their partners. The majority of participants (88.1%) intended to share the information with others who take care of their infants. CONCLUSION The PURPLE abusive head trauma prevention program demonstrated positive preliminary results in knowledge and intended behavior among a population of majority Spanish-speaking participants. These findings offer an important first step toward provision of effective universal abusive head trauma prevention among growing Spanish-speaking populations. Further evaluation is needed of acceptability, retention of messages, and postintervention behavior change among Spanish-speaking participants and nurses.
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Affiliation(s)
| | | | | | | | - Jane L Cassel
- 2 University Medical Center Brackenridge, Austin, TX, USA
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Puls HT, Anderst JD, Bettenhausen JL, Masonbrink A, Markham JL, Plencner L, Krager M, Johnson MB, Walker JM, Greeley CS, Hall M. Potential Opportunities for Prevention or Earlier Diagnosis of Child Physical Abuse in the Inpatient Setting. Hosp Pediatr 2018; 8:hpeds.2017-0109. [PMID: 29371238 DOI: 10.1542/hpeds.2017-0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To compare rates of previous inpatient visits among children hospitalized with child physical abuse (CPA) with controls as well as between individual abuse types. METHODS In this study, we used the Pediatric Health Information System administrative database of 44 children's hospitals. Children <6 years of age hospitalized with CPA between January 1, 2011, and September 30, 2015, were identified by discharge codes and propensity matched to accidental injury controls. Rates for previous visit types were calculated per 10 000 months of life. χ2 and Poisson regression were used to compare proportions and rates. RESULTS There were 5425 children hospitalized for CPA. Of abuse and accident cases, 13.1% and 13.2% had a previous inpatient visit, respectively. At previous visits, abused children had higher rates of fractures (rate ratio [RR] = 3.0 times; P = .018), head injuries (RR = 3.5 times; P = .005), symptoms concerning for occult abusive head trauma (AHT) (eg, isolated vomiting, seizures, brief resolved unexplained events) (RR = 1.4 times; P = .054), and perinatal conditions (eg, prematurity) (RR = 1.3 times; P = .014) compared with controls. Head injuries and symptoms concerning for occult AHT also more frequently preceded cases of AHT compared with other types of abuse (both P < .001). CONCLUSIONS Infants hospitalized with perinatal-related conditions, symptoms concerning for occult AHT, and injuries are inpatient populations who may benefit from abuse prevention efforts and/or risk assessments. Head injuries and symptoms concerning for occult AHT (eg, isolated vomiting, seizures, and brief resolved unexplained events) may represent missed opportunities to diagnose AHT in the inpatient setting; however, this requires further study.
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Affiliation(s)
| | - James D Anderst
- Child Abuse and Neglect, Department of Pediatrics, Children's Mercy Hospital, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | | | | | | | | | | | - Christopher S Greeley
- Division of Child Abuse and Neglect, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Matthew Hall
- Divisions of Hospital Medicine and
- Children's Hospital Association, Lenexa, Kansas
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Abstract
OBJECTIVES This study aimed to assess management of pediatric isolated skull fracture (ISF) patients by determining frequency of admission and describing characteristics associated with patients admitted for observation compared with patients discharged directly from the emergency department (ED) and those requiring a prolonged hospitalization. METHODS We evaluated children younger than 5 years who presented with ISF using the South Carolina Traumatic Brain Injury Surveillance and Registry System data from 2001 to 2011. Outcomes analyzed included discharged from ED, admitted for less than 24 hours, and admitted for more than 24 hours (prolonged hospitalization). Bivariate analyses and a polytomous logistic regression model identified factors associated with patient disposition. RESULTS Five hundred twenty-seven patients met the study criteria (ED discharge = 283 [53%]; inpatient <24 hours = 156 [29%]; inpatient >24 hours = 88 [18%]). The mean length of stay for admissions was 1.9 (SD, 1.5) days. In the regression model, ED discharges had greater odds of presenting to levels 2 to 3 hospitals (level 2: odds ratio [OR], 6.16; 95% confidence interval [CI], 3.66-10.39; level 3: OR, 30.98; 95% CI, 10.92-87.91) and lower odds of a high poverty status (OR, 0.20; 95% CI, 0.10-0.40). Prolonged hospitalizations had greater odds of concomitant injuries (OR, 2.21; 95% CI, 1.12-4.36). CONCLUSIONS Admission after ISF is high despite a low risk of deterioration. High-poverty patients presenting to high-acuity medical centers are more commonly admitted for observation. Only presence of concomitant injuries was clinically predictive of prolonged hospitalization. The ability to better stratify risk after pediatric ISF would help providers make more informed decisions regarding ED disposition.
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Sato A, Kikuchi N, Yokota S. Inadequate sociomedical evaluation of possible abusive head trauma in Yokohama. Pediatr Int 2016; 58:445-9. [PMID: 26513132 DOI: 10.1111/ped.12840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/11/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND There have been no previous studies on the adequacy of combined evaluation of possible abusive head trauma cases by frontline medical personnel, hospital-based child protection teams, and child protective services in local districts of Japan. METHODS We conducted a questionnaire survey of hospitalized patients under 24 months old with a diagnosis of intracranial hemorrhage (ICH) from January 2011 to December 2013. Eleven large-scale general hospitals in Yokohama, Japan were surveyed, which provide centralized inpatient care to moderately-severely ill children. RESULTS A total of 51 ICH patients were listed from eight hospitals. Median patient age was 7 months, and 84% were younger than 12 months. The most common diagnosis on computed tomography was subdural hematoma (n = 26; 51%). Of a total of 51 cases, 31 (61%) occurred inside the home; the injury scene was unknown in six cases (12%). We reviewed these 37 cases from the viewpoint of evaluation with concern for suspected child abuse. Three out of 37 patients (8%) were not examined for inflicted skin lesions, and skeletal surveys and funduscopy were not conducted in 14 (38%) and 15 (41%), respectively. Thirteen out of 37 cases (35%) were not reported to hospital-based child protection teams and 22 (59%) were not reported to regional child protective services. CONCLUSION The sociomedical evaluation of possible child abuse appears to be systematically inadequate in Yokohama.
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Affiliation(s)
- Atsuo Sato
- Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Kanagawa, Japan.,Department of Pediatrics, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Nobuyuki Kikuchi
- Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Kanagawa, Japan.,Department of Pediatrics, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Shumpei Yokota
- Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Kanagawa, Japan.,Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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13
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Nuño M, Pelissier L, Varshneya K, Adamo MA, Drazin D. Outcomes and factors associated with infant abusive head trauma in the US. J Neurosurg Pediatr 2015; 16:515-522. [PMID: 26230462 DOI: 10.3171/2015.3.peds14544] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Head trauma is the leading cause of death in abused children, particularly prior to the age of 2 years. An awareness of factors associated with this condition as well as with a higher risk of mortality is important to improve outcomes and prevent the occurrence of these events. The objective of this study was to evaluate outcomes and factors associated with poor outcomes in infants with diagnosed abusive head trauma (AHT). Patient characteristics, socioeconomic factors, and secondary conditions such as retinal bleeding, contusion, and fractures were considered. METHODS Data were obtained from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. From the Kids' Inpatient Database (KID) sample, the authors identified infants no older than 23 months who had been diagnosed with AHT in 2000, 2003, 2006, and 2009. All statistical analyses were conducted in SAS 9.2. Descriptive statistics were provided, and multivariate logistic regression models were applied to evaluate factors associated with mortality and nonroutine discharge. RESULTS A total of 5195 infants were analyzed in this study. Most infants (85.5%) had ages ranging between 0 and 11 months and were male (61.6%). Overall mortality was 10.8%, with a rate of 9.8% in the 0- to 11-month-old cohort and 16.5% in the 12- to 23-month-olds (p = 0.0003). The overall nonroutine discharge rate of 25.6% increased significantly from 23.3% to 39.0% with increasing age (0-11 vs 12-23 months of age, p < 0.0001). Assuming a multivariate model that adjusted for multiple confounders, the authors found that older infants (12-23 vs 0-11 months, OR 1.81, 95% CI 1.18-2.77) with a secondary diagnosis of retinal bleeding (OR 2.85, 95% CI 2.02-4.00) or shaken baby syndrome (OR 2.09, 95% CI 1.48-2.94) had an increased risk of mortality; these factors were similarly associated with an increased odds of a nonroutine discharge. A higher income ($30,001-$35,000 vs $1-$24,999) was associated with a reduction in the odds of mortality (OR 0.46, 95% CI 0.29-0.72). In the subset of cases (1695 [32.6%]) that specified the perpetrator involved in infant injury, the authors found that the father, stepfather, or boyfriend was most frequently reported (67.4%). A trend for a higher AHT incidence was documented in the early ages (peak at 2 months) compared with older ages. CONCLUSIONS Despite the higher incidence of AHT among infants during the earlier months of life, higher mortality was documented in the 12- to 23-month-olds. Retinal bleeding and shaken baby syndrome were secondary diagnoses associated with higher mortality and nonroutine discharge. Males (67.4%) were overwhelmingly documented as the perpetrators involved in the injury of these infants.
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Affiliation(s)
- Miriam Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Lindsey Pelissier
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Kunal Varshneya
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical Center Hospital, Albany, New York
| | - Doniel Drazin
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and
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Peterson C, Xu L, Florence C, Parks SE. Annual Cost of U.S. Hospital Visits for Pediatric Abusive Head Trauma. CHILD MALTREATMENT 2015; 20:162-169. [PMID: 25911437 PMCID: PMC4675617 DOI: 10.1177/1077559515583549] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We estimated the frequency and direct medical cost from the provider perspective of U.S. hospital visits for pediatric abusive head trauma (AHT). We identified treat-and-release hospital emergency department (ED) visits and admissions for AHT among patients aged 0-4 years in the Nationwide Emergency Department Sample and Nationwide Inpatient Sample (NIS), 2006-2011. We applied cost-to-charge ratios and estimated professional fee ratios from Truven Health MarketScan(®) to estimate per-visit and total population costs of AHT ED visits and admissions. Regression models assessed cost differences associated with selected patient and hospital characteristics. AHT was diagnosed during 6,827 (95% confidence interval [CI] [6,072, 7,582]) ED visits and 12,533 (95% CI [10,395, 14,671]) admissions (28% originating in the same hospital's ED) nationwide over the study period. The average medical cost per ED visit and admission were US$2,612 (error bound: 1,644-3,581) and US$31,901 (error bound: 29,266-34,536), respectively (2012 USD). The average total annual nationwide medical cost of AHT hospital visits was US$69.6 million (error bound: 56.9-82.3 million) over the study period. Factors associated with higher per-visit costs included patient age <1 year, males, coexisting chronic conditions, discharge to another facility, death, higher household income, public insurance payer, hospital trauma level, and teaching hospitals in urban locations. Study findings emphasize the importance of focused interventions to reduce this type of high-cost child abuse.
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Affiliation(s)
- Cora Peterson
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Atlanta, GA, USA
| | - Likang Xu
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Atlanta, GA, USA
| | - Curtis Florence
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Atlanta, GA, USA
| | - Sharyn E Parks
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Atlanta, GA, USA
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Abstract
OBJECTIVE The purpose of this article is to review the constellation of findings of abusive head trauma, which may be accompanied by injuries to the appendicular and axial skeleton, brain and spinal cord, and retina. Additional common features include skin and soft-tissue injury, visceral findings, and evidence of oral trauma. CONCLUSION The evidence base for abusive head trauma encompasses diverse disciplines, including diagnostic imaging, pathology, pediatrics, biomechanics, ophthalmology, epidemiology, and orthopedics. When the varied sources of evidence are pieced together and taken in toto, abusive head trauma is often readily differentiated from alternative explanations of an infant's injuries.
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Imagawa KK, Hamilton A, Ceschin R, Tokar E, Pham P, Bluml S, Wisnowski J, Panigrahy A. Characterization of microstructural injury: a novel approach in infant abusive head trauma-initial experience. J Neurotrauma 2014; 31:1632-8. [PMID: 24831582 DOI: 10.1089/neu.2013.3228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abusive head trauma (AHT) is the leading cause of morbidity and mortality among abused children, yet the neuroanatomical underpinnings of AHT outcome is incompletely understood. The aim of this study was to characterize white matter (WM) abnormalities in infants with AHT using diffusion tensor imaging (DTI) and determine which microstructural abnormalities are associated with poor outcome. Retrospective DTI data from 17 infants (>3 months) with a diagnosis of AHT and a comparison cohort of 34 term infants of similar post-conceptual age (PCA) were compared using a voxel-based DTI analysis of cerebral WM. AHT cases were dichotomously classified into mild/moderate versus severe outcome. Clinical variables and conventional imaging findings were also analyzed in relation to outcome. Outcomes were classified in accordance with the Pediatric Cerebral Performance Category Score (PCPCS). Reduced axial diffusivity (AD) was shown in widespread WM regions in the AHT infants compared with controls as well as in the AHT severe outcome group compared with the AHT mild/moderate outcome group. Reduced mean diffusivity (MD) was also associated with severe outcome. Radial diffusivity (RD), conventional magnetic resonance findings, brain metric measurements, and clinical/laboratory variables (with the exception of Glascow Coma Scale) did not differ among AHT outcome groups. Findings support the unique role of DTI techniques, beyond conventional imaging, in the evaluation of microstructural WM injury of AHT. Reduced AD (likely reflecting axonal damage) and MD were associated with poor clinical outcome. DTI abnormalities may uniquely reflect AHT patterns of axonal injury that are not characterized by conventional imaging, which may have both therapeutic and prognostic implications.
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Affiliation(s)
- Karen Kay Imagawa
- 1 Department of Pediatrics, Children's Hospital Los Angeles , Los Angeles, California
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