Characteristics and Trends of Hospitalized Pediatric Abuse Head Trauma in Wuhan, China: 2002–2011

Xia, Xin; Xiang, Joe; Shao, Jianbo; Smith, Gary A.; Yu, Chuanhua; Zhu, Huiping; Xiang, Hao

doi:10.3390/ijerph9114187

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…Whereas many prior studies have viewed AHT from a state or nationwide perspective, 3,13,20,24,25,29,31 our study was designed to examine the disease through the lens of a single hospital to provide a local epidemiological perspective. AHT is disproportionately a malady of the poor.…”

Section: Discussion Our Resultsmentioning

confidence: 99%

Abusive head trauma: an epidemiological and cost analysis

Boop

Axente

Weatherford

et al. 2016

PED

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OBJECTIVE Research on pediatric abusive head trauma (AHT) has largely focused on clinical presentation and management. The authors sought to review a single-institution experience from a public health perspective to gain a better understanding of the local population affected, determine overall incidence and seasonal trends, and provide details on the initial hospitalization, including extent of injuries, neurosurgical interventions, and hospital charges. METHODS All cases of AHT involving patients who presented to Le Bonheur Children's Hospital (LBCH) from 2009 through 2014 were identified. AHT was defined as skull fracture or intracranial hemorrhage in a child under the age of 5 years with a suspicious mechanism or evidence of other intentional injuries, such as retinal hemorrhages, old or new fractures, or soft-tissue bruising. Injuries were categorized as Grade I (skull fracture only), Grade II (intracranial hemorrhage or edema not requiring surgical intervention), or Grade III (intracranial hemorrhage requiring intervention or death due to brain injury). RESULTS Two hundred thirteen AHT cases were identified. The demographics of the study population are similar to those reported in the literature: the majority of the patients involved were 6 months of age or younger (55%), male (61%), African American (47%), and publicly insured (82%). One hundred one neurosurgical procedures were performed in 58 children, with the most common being bur hole placement for treatment of subdural collections (25%) and decompressive hemicraniectomy (22%). The annual incidence rate rose from 2009 (19.6 cases per 100,000 in the population under 5 years of age) to 2014 (47.4 cases per 100,000) and showed seasonal peaks in January, July, and October (6-year average single-month incidence, respectively, 24.7, 21.7, and 24.7 per 100,000). The total hospital charges were $13,014,584, with a median cost of $27,939. Treatment costs for children who required surgical intervention (i.e., those with Grade III) were up to 10 times those of children with less severe injuries. CONCLUSIONS In the authors' local population, victims of AHT are overwhelmingly infants, are more often male than female, and are disproportionately from lower socioeconomic ranks. The incidence is increasing and initial hospitalization charges are substantial and variable. The authors introduce a simple 3-tiered injury classification scheme that adequately stratifies length of hospital stay and cost.

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Section: Discussion Our Resultsmentioning

confidence: 99%

Abusive head trauma: an epidemiological and cost analysis

Boop

Axente

Weatherford

et al. 2016

PED

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“…This suggests that, in a Canadian context, S01 codes do not necessarily capture TBI. Also, two of the articles that specifically examined the incidence and trends of TBI in children and youth [ 47 , 51 ] utilized the United States Centre for Disease Control and Prevention (CDC) ICD-10 definition for TBI, which is used to identify TBI related deaths [ 22 , 53 ]. This suggests that further research is warranted to inform the inclusion of S01 codes in the definition of TBI, especially for morbidity rather than mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Limitations of this review include the small number of papers that specifically examined children and youth with TBI. Also, the case definitions used were often modeled after the CDC’s ICD-10 definition for TBI related deaths, even if the objective of the paper was to capture TBI related ED visits or acute care admissions [ 47 , 51 , 60 ]. The CDC ICD case definition, in particular, the unspecified head injury codes, is influenced in part by coding practices [ 107 ].…”

Section: Discussionmentioning

confidence: 99%

Defining pediatric traumatic brain injury using International Classification of Diseases Version 10 Codes: A systematic review

2015

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BackgroundAlthough healthcare administrative data are commonly used for traumatic brain injury (TBI) research, there is currently no consensus or consistency on the International Classification of Diseases Version 10 (ICD-10) codes used to define TBI among children and youth internationally. This study systematically reviewed the literature to explore the range of ICD-10 codes that are used to define TBI in this population. The identification of the range of ICD-10 codes to define this population in administrative data is crucial, as it has implications for policy, resource allocation, planning of healthcare services, and prevention strategies.MethodsThe databases MEDLINE, MEDLINE In-Process, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Database of Systematic Reviews were systematically searched. Grey literature was searched using Grey Matters and Google. Reference lists of included articles were also searched for relevant studies. Two reviewers independently screened all titles and abstracts using pre-defined inclusion and exclusion criteria. A full text screen was conducted on articles that met the first screen inclusion criteria. All full text articles that met the pre-defined inclusion criteria were included for analysis in this systematic review.ResultsA total of 1,326 publications were identified through the predetermined search strategy and 32 articles/reports met all eligibility criteria for inclusion in this review. Five articles specifically examined children and youth aged 19 years or under with TBI. ICD-10 case definitions ranged from the broad injuries to the head codes (ICD-10 S00 to S09) to concussion only (S06.0). There was overwhelming consensus on the inclusion of ICD-10 code S06, intracranial injury, while codes S00 (superficial injury of the head), S03 (dislocation, sprain, and strain of joints and ligaments of head), and S05 (injury of eye and orbit) were only used by articles that examined head injury, none of which specifically examined children and youth.ConclusionThis review provides evidence for discussion on how best to use ICD codes for different goals. This is an important first step in reaching an appropriate definition and can inform future work on reaching consensus on the ICD-10 codes to define TBI for this vulnerable population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0259-7) contains supplementary material, which is available to authorized users.

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“…14 In a study of 3061 children (aged < 5 years) in China with traumatic brain injury studied over 10 years, AHT was suspected in 140 children and 68.6% of AHT occurred in infants aged less than 1 year. 15 In a prospective study of 225 pediatric injuries (aged 2 monthse12 years) from the All India Institute of Medical Sciences, New Delhi (March 2006eFebruary 2007), child abuse was identified in 7/225 cases (3.5%). 1 Although accurate figures are not available for the Indian subcontinent, it is presumed not to be too dissimilar.…”

Section: Incidencementioning

confidence: 99%

The importance of recognizing abusive head trauma in the neurosurgical setting

Paul

Kane

2014

The Indian Journal of Neurotrauma

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Abusive head trauma (AHT) occurs due to an intentional abrupt impact and/or violent shaking leading to an injury to the skull or intracranial contents of a baby or child, usually younger than 2 years of age. Without impact, there may be no external signs of head trauma. It is the leading cause of mortality in children who have suffered intentional physical abuse. It is more likely to occur in very young children with an estimated prevalence of 1 per 3000 in infants under 6 months of age. Studies have highlighted that distressed and exhausted parents can sometimes shake their infant in desperation and parental education has been shown to decrease the incidence of AHT. Clinicians dealing with children who presents with traumatic brain injury (TBI) should always consider the possibility of AHT. AHT is classically characterized by a triad of signs; subdural hematoma, brain edema, and retinal hemorrhage, however, non-specific features may also be seen in clinical practice both acutely or subsequently. Certain neuroradiological findings (subdural hemorrhages, multiple interhemispheric convexity and posterior fossa hemorrhages, hypoxic-ischemic injury and cerebral edema) are suggestive of AHT in young children. Associated spinal injuries can be easily missed and it is important to investigate for this. This review article includes 2 illustrative case studies and gives a comprehensive overview of AHT in children which we hope will be useful for neurosurgeons in their clinical practice. Child protection is everyone's responsibility and is best achieved when different specialties and professionals work together.

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Characteristics and Trends of Hospitalized Pediatric Abuse Head Trauma in Wuhan, China: 2002–2011

Cited by 10 publications

References 34 publications

Abusive head trauma: an epidemiological and cost analysis

Abusive head trauma: an epidemiological and cost analysis

Defining pediatric traumatic brain injury using International Classification of Diseases Version 10 Codes: A systematic review

The importance of recognizing abusive head trauma in the neurosurgical setting

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