Development of Guidelines for Skeletal Survey in Young Children With Intracranial Hemorrhage

Paine, Christine Weirich; Scribano, Philip V.; Localio, Russell; Wood, Joanne N.

doi:10.1542/peds.2015-3024

Cited by 19 publications

(16 citation statements)

References 21 publications

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“…[37] Likewise, we propose that researchers and pediatric medical providers agree to a standardized de nition and diagnostic guidelines for possible and con rmed SBS, much like the AHT guidelines proposed by CDC, which may help reduce discrepancies in diagnosis and treatment and improve options for surveillance. [38] , [39] Finally, our ndings on the patient and hospital characteristics associated with SBS diagnoses align with what is known about AHT in the literature. Like AHT, our ndings indicate that all abuse types were diagnosed more frequently among infants (<1-year-old), boys, and children from low-income households than toddlers, girls, and children from higher-income households.…”

Section: Discussionsupporting

confidence: 83%

Trends in Shaken Baby Syndrome Diagnoses Among Young Children Hospitalized for Abuse

Conrad

Butcher

Oral

et al. 2020

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Objective To investigate national trends of SBS diagnosis codes and how trends varied among patient and hospital characteristics. Methods We examined possible SBS, confirmed SBS, total SBS, and non-SBS abuse diagnoses among children age three and younger who were hospitalized for abuse between 1998 and 2014 using a secondary analysis of the National Inpatient Sample, the largest US all-payer inpatient care database (N = 66,854). A baseline category logit model was used based on a quasi-likelihood approach (QIC) with an independent working correlation structure. Results The rate (per 100,000 census population) of total SBS diagnoses was 5.4 (± 0.3) between 1998 and 2014, whereas the rate of non-SBS abuse was 19.6 (± 1.0).The rate of confirmed SBS diagnoses increased from 3.8 (± 0.3) in 1998 to 5.1 (± 0.9) in 2005, and decreased to 1.3 (± 0.2) in 2014. Possible SBS diagnoses were 0.6 (± 0.2) in 1998, increasing to 2.4 (± 0.4) in 2014. Confirmed SBS diagnoses have declined since 2002, while possible SBS diagnoses have increased. All abuse types were more frequent among infants, males, children from low-income homes, and urban teaching hospitals. Conclusions We investigated seventeen-year trends of SBS diagnoses among young children hospitalized for abuse. The discrepancy between trends in possible and confirmed SBS suggests differences in norms for diagnosing SBS, which has implications for which cases are considered AHT. Future research should investigate diagnostic processes for SBS and whether all codes associated with abusive head injuries in young children are classified as AHT. Our findings also highlight the relativity defining and diagnosing SBS. Medical professionals find utility in diagnosing SBS, though may be more apt to apply possible SBS diagnoses to abusive head injuries in children. Clarifying norms for SBS diagnosis and refining definitions for AHT will ensure that young children presenting with abusive head injuries are included in overall counts of AHT. This baseline data, an essential component of child abuse surveillance, will enable ongoing efforts to track, prevent, and reduce child abuse.

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Section: Discussionsupporting

confidence: 83%

Trends in Shaken Baby Syndrome Diagnoses Among Young Children Hospitalized for Abuse

Conrad

Butcher

Oral

et al. 2020

Preprint

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“…The AAP (2000; 2009; (Christian & Committee on Child Abuse and Neglect, 2015)) reaffirmed their SS recommendations in 2000, 2009 and 2015. Since 1997, the American College of Radiology (ACR) and The Society for Pediatric Radiology (2006; 2011; 2014; 2016) have also published practice parameters recommending that SSs be performed in infants and young children who are suspected victims of abuse. However, in clinical practice, determining which young, injured children warrant evaluation for suspected abuse and a SS can be challenging.…”

mentioning

confidence: 99%

Skeletal surveys in young, injured children: A systematic review

Paine

Wood

2018

Child Abuse & Neglect

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Skeletal surveys (SSs) have been identified as a key component of the evaluation for suspected abuse in young children, but variability in SS utilization has been reported. Thus, we aimed to describe the utilization patterns, yield, and risks of obtaining SS in young children through a systematic literature review. We searched PubMed/MEDLINE and CINAHL databases for articles published between 1990 and 2016 on SS. We calculated study-specific percentages of SS utilization and detection of occult fractures and examined the likelihoods that patient characteristics predict SS utilization and detection of occult fractures. Data from 32 articles represents 64,983 children <60months old. SS utilization was high (85%-100%) in studies of infants evaluated by a child protection team for suspected abuse and/or diagnosed with abuse except in one study of primarily non-pediatric hospitals. Greater variability in SS utilization was observed across studies that included all infants with specific injuries, such as femur fractures (0%-77%), significant head injury (51%-82%), and skull fractures (41%-86%). Minority children and children without private insurance were evaluated with SS more often than white children and children with private insurance despite lack of evidence to support this practice. Among children undergoing SS, occult fractures were frequently detected among infants with significant head injury (23%-34%) and long bone fractures (30%) but were less common in infants with skull fractures (1%-6%). These findings underscore the need for interventions to decrease disparities in SS utilization and standardize SS utilization in infants at high risk of having occult fractures.

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“…38 The Period of PURPLE Crying, for example, is a prevention campaign designed by the National Center on Shaken Baby Syndrome and well known for its empirical support. 34,35 Given our findings and the evidence on prevention programs, prevention programs should be expanded to more locations and offered to more expecting parents.…”

Section: Discussionmentioning

confidence: 90%

“…Likewise, we propose that researchers and pediatric medical providers agree to a standardized definition and diagnostic guidelines for SBS, much like the AHT guidelines proposed by CDC, which may help reduce discrepancies in diagnosis and treatment and improve options for surveillance. 35,36 The distinct biomechanics and etiology of SBS have implications for pediatric education, research, and prevention. Biomechanics research is a main source of evidence about the mechanisms by which shaking injures the pediatric brain.…”

Section: Discussionmentioning

confidence: 99%

Trends in Shaken Baby Syndrome Diagnoses Among Young Children Hospitalized for Abuse

Conrad

Butcher

Oral

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective To investigate national trends of SBS diagnosis codes and how trends varied among patient and hospital characteristics. Methods We examined possible and confirmed SBS diagnoses among children age three and younger who were hospitalized for abuse between 1998 and 2014 using a secondary analysis of the National Inpatient Sample, the largest US all-payer inpatient care database ( N = 52,562). A baseline category logit model was used based on a quasi-likelihood approach (QIC) with an independent working correlation structure. Results The rate of confirmed SBS diagnoses increased from 3.8 (± 0.3) in 1998 to 5.1 (± 0.9) in 2005, and decreased to 1.3 (± 0.2) in 2014. Possible SBS diagnoses were 0.6 (± 0.2) in 1998, and increased to 2.4 (± 0.4) in 2014. Confirmed SBS diagnoses have declined since 2002, while possible SBS diagnoses have increased. Possible SBS diagnoses were more common among urban teaching hospitals and small to medium hospitals than for other hospital types. Conclusions We investigated seventeen-year trends of SBS diagnoses among young children hospitalized for abuse. The discrepancy between trends in possible and confirmed SBS suggests differences in diagnostic norms for SBS and related conditions. Researchers should examine diagnostic processes for SBS and investigate why cases are diagnosed as SBS or a related diagnosis. We propose that researchers and pediatric medical providers agree to a standardized definition and diagnostic guidelines for SBS, much like the AHT guidelines proposed by CDC, which may help reduce discrepancies in diagnosis and improve options for surveillance.

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Development of Guidelines for Skeletal Survey in Young Children With Intracranial Hemorrhage

Cited by 19 publications

References 21 publications

Trends in Shaken Baby Syndrome Diagnoses Among Young Children Hospitalized for Abuse

Trends in Shaken Baby Syndrome Diagnoses Among Young Children Hospitalized for Abuse

Skeletal surveys in young, injured children: A systematic review

Trends in Shaken Baby Syndrome Diagnoses Among Young Children Hospitalized for Abuse

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