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

Shanahan, Meghan; Zolotor, Adam J.; Parrish, Jared W.; Barr, Ronald G.; Runyan, Desmond K.

doi:10.1542/peds.2013-2049

Cited by 84 publications

(59 citation statements)

References 17 publications

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“…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). Other possible explanations for the differences in reported cases may be other external factors such as economy or unemployment, which can vary across regions.…”

Section: Discussionmentioning

confidence: 82%

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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Section: Discussionmentioning

confidence: 82%

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

Nuño

Pelissier

Varshneya

et al. 2015

PED

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“…4 A retrospective study using the Centers for Disease Control and Prevention definition of AHT demonstrated a rate of ∼1 in 3000 infants. 5 Studies in other countries suggest similar incidences. 6,7 Proper diagnosis of mild AHT is difficult because caretakers rarely provide an accurate history, 8 infants present with nonspecific symptoms, such as vomiting or fussiness, and physical examination is often normal.…”

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confidence: 85%

Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma

Berger

Fromkin²,

Herman

et al. 2016

Pediatrics

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BACKGROUND: Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head.

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“…4 La incidencia del traumatismo encefalocraneano abusivo es imprecisa y subestimada; según autores, oscila entre 11 y 40,5 casos por cada 100 000 niños por debajo del año de edad. [5][6][7] Las lesiones encefálicas derivadas de este síndrome son las que habitualmente conducen a estos pacientes a una situación de muerte cerebral.…”

Section: Donación De óRganos Tras Muerte Encefálica Debida a Maltratounclassified

Donación de órganos tras muerte encefálica debida a maltrato infantil

et al. 2015

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Presentación de casos clínicos RESUMENMás del 40 por ciento de las muertes por maltrato infantil se producen entre los niños menores de 5 años. El patrón de lesión es el traumatismo encefalocraneano abusivo, que, en los casos más graves, conduce a la muerte cerebral. La donación de órganos en menores de 5 años es poco frecuente. Se describen dos casos de maltrato infantil que causó la muerte encefálica en un niño de un mes y otro de cuatro años de edad, quienes posteriormente fueron candidatos para la donación de órganos. Es crucial la existencia de una buena coordinación entre los equipos sanitarios, de asistencia social y jurídica para intentar obtener la donación de órganos en los casos de muerte encefálica secundaria a maltrato. Palabras clave: muerte encefálica, maltrato infantil, donación de órganos. ABSTRACTMore than 40 percent of deaths from child abuse occur among children younger than 5 years. The injury pattern in child abuse is block abuse head trauma which in the most severe cases produces brain death. Organ donation is uncommon in children younger than five years. We describe two cases of child abuse that caused brain death; subsequently they were subsidiary for organ donation. It is very important to establish a good coordination between health, social care and legal assistance teams to obtain organ donation.

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

Cited by 84 publications

References 17 publications

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

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

Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma

Donación de órganos tras muerte encefálica debida a maltrato infantil

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