Demographics of abusive head trauma in the Commonwealth of Pennsylvania

Kesler, Henry; Dias, Mark S.; Shaffer, Michele L.; Rottmund, Carroll M.; Cappos, Kelly M.; Thomas, Neal J.

doi:10.3171/ped/2008/1/5/351

Cited by 61 publications

(46 citation statements)

References 21 publications

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“…This was a strong supplemental argument for AHT since retinal hemorrhages have been considered in previous reports as specific signs of abuse from a shaking mechanism when associated with SDH in neonates and toddlers without a clear history of trauma. 1,[8][9][10][12][13][14]16,19,22,[24][25][26]29 SDH is the most common finding on cranial CT scans of patients who are victims of AHT (present in > 70% of cases); 2,3,7,8,23 it is commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages 3,7,8,30 as we found in our sample. The SDHs in our patients were sometimes exclusively hyperdense (acute) or heterogeneous (acute and subacute), due to the natural sedimentation, accumulation of CSF and hemoglobin oxidation in different stages, or were homogeneously hypodense as described by some authors.…”

Section: Discussionsupporting

confidence: 48%

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

Melo

Rocco²,

Bourgeois³

et al. 2014

PED

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Object Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols. The authors report their experience and discuss the routine surgical options in the management of traumatic SDH at a Level 1 Pediatric Trauma Center. Methods In this paper, the authors describe a cross-sectional study with consecutive revision of data described in the medical records of Hôpital Universitaire Necker–Enfants Malades between January 2008 and January 2013. During this period, all children younger than 2 years of age who were admitted with a traumatic SDH identified on CT scans were included in this study. Results One hundred eighty-four children who had SDH and were younger than 2 years of age were included. Their median age was 5.8 months (range 5 days–23 months), and 70% of the children were male. On admission CT scans, the SDH was bilateral in 52% of cases and homogeneously hypodense in 77%. Neurosurgical treatment was undertaken in 111 children (60%) with an admission Glasgow Coma Scale score of 12 or less, bulging fontanels, or other signs suggestive of intracranial hypertension. The first surgical option was craniotomy in 1.8% (2) of these 111 cases, decompressive craniectomy in 1.8% (2), transcutaneous subdural puncture in 15% (17), external subdural drainage in 16% (18), subdural-subgaleal shunt placement in 17% (19), and subdural-peritoneal shunt placement in 48% (53). In 82% of the children initially treated with transcutaneous subdural puncture and in 50% of those treated with external subdural drainage, increase or persistence of the SDH, CSF or skin infection, or shunt system malfunction was observed and further surgical intervention was required. There was a 26% rate of complications in patients initially treated with a subdural-peritoneal shunt. Although 52% of the patients had bilateral SDH, bilateral drainage was only required in 9.4%. Conclusions The choice of treatment should be determined by the clinical and radiological characteristics of the individual case. Although effective on an emergency basis, subdural puncture and external subdural drainage are frequently insufficient to obtain complete resolution of SDH, and temporary placement of a subdural-peritoneal shunt is needed in most cases.

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Section: Discussionsupporting

confidence: 48%

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

Melo

Rocco²,

Bourgeois³

et al. 2014

PED

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“…We know of 2 studies, both of which were conducted in the Northeast, that reported reductions in AHT cases ranging from 47% to 75% as a result of AHT prevention programs. 6,22 It is also possible that ICD-9-CM coding practices differ between regions, which would affect the rates found in the current analysis. Finally, there may be other external influences on AHT rates, such as the economy or unemployment, that differ between regions.…”

Section: Discussionmentioning

confidence: 61%

“…Additionally, we missed AHT cases among olderchildren by restricting ouranalyses to children ,1 year of age. However, the incidence of AHT is much lower among children in the second year of life 2,6 than during infancy. Given that discharge data were used, it was not possible to verify that the CDC algorithm accurately identified children with AHT, resulting in likely misclassification.…”

Section: Discussionmentioning

confidence: 98%

“…1 It was first described .40 years ago, and the epidemiology of AHT is now more clearly understood, with reported rates of approximately 15-30 per 100 000 in the first year of life. [2][3][4][5][6] This translates to about 1200 cases among children ,1 year of age per year in the United States. Nearly one-fourth of children ,2 die, and the costs to the child, family, health system, and society are enormous.…”

mentioning

confidence: 99%

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National, Regional, and State Abusive Head Trauma: Application of the CDC Algorithm

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Abusive head trauma (AHT) is a rare phenomenon that results in devastating injuries to children. It is necessary to analyze large samples to examine changes in rates over time. WHAT THIS STUDY ADDS:This is the first study to examine rates of AHT at the national, regional, and state level. The results provide a more detailed description of AHT trends than has been previously available. abstract OBJECTIVE: To examine national, regional, and state abusive head trauma (AHT) trends using child hospital discharge data by applying a new coding algorithm developed by the Centers for Disease Control and Prevention (CDC). METHODS:Data from 4 waves of the Kids' Inpatient Database and annual discharge data from North Carolina were used to determine trends in AHT incidence among children ,1 year of age between 2000 and 2009. National, regional, and state incidence rates were calculated. Poisson regression analyses were used to examine national, regional, and state AHT trends. RESULTS:The CDC narrow and broad algorithms identified 5437 and 6317 cases, respectively, in the 4 years of KID weighted data. This yielded average annual incidences of 33.4 and 38.8 cases per 100 000 children ,1 year of age. There was no statistically significant change in national rates. There were variations by region of the country, with significantly different trends in the Midwest and West. State data for North Carolina showed wide annual variation in rates, with no significant trend. CONCLUSIONS:The new coding algorithm resulted in the highest AHT rates reported to date. At the same time, we found large but statistically insignificant annual variations in AHT rates in 1 large state. This suggests that caution should be used in interpreting AHT trends and attributing changes in rates as being caused by changes in policies, programs, or the economy. Pediatrics 2013;132:e1546-e1553 AUTHORS:

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“…Kesler et al and Altman et al reported a greater concentration of AHT prevention programs in the northern states. 1,15 As noted in Shanahan et al, it is also possible that differences in ICD-9-CM coding practices affect the rates reported by authors using administrative databases. 25 In a preliminary exploration of the KID database, we found that northern states were much more likely to document SBS than western states (54.8% vs 35.0%, p = 0.004).…”

Section: Discussionmentioning

confidence: 95%

Outcomes and factors associated with infant abusive head trauma in the US

Nuño

Pelissier

Varshneya

et al. 2015

PED

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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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Demographics of abusive head trauma in the Commonwealth of Pennsylvania

Cited by 61 publications

References 21 publications

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

National, Regional, and State Abusive Head Trauma: Application of the CDC Algorithm

Outcomes and factors associated with infant abusive head trauma in the US

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