Demographics of abusive head trauma in the Commonwealth of Pennsylvania

Henry Kesler M.D. 1 , Mark S. Dias M.D. 1 , Michele Shaffer Ph.D. 2 , Carroll Rottmund R.N., B.S.N. 1 , Kelly Cappos R.N., B.S.N. 1 , and Neal J. Thomas M.D., M.Sc. 2 , 3
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  • 1 Departments of Neurosurgery,
  • 2 Public Health Sciences, and
  • 3 Pediatrics, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Object

The aim of this study was to characterize the prevalence and demographic features of abusive head trauma (AHT) among infants and children < 36 months of age in Pennsylvania.

Methods

The authors included all cases of substantiated AHT involving children < 36 months of age in Pennsylvania between 1996 and 2002 that had been reported to a statewide registry. Demographic information was derived from child abuse reports and birth certificates; the study cohort was contrasted with all infants born in Pennsylvania during the same period.

Results

The study identified 327 cases. The incidence was 14.7 cases (95% confidence interval 13.1–16.5) per 100,000 person-years for the first 2 years of life with a higher incidence during the 1st year (26.0 cases per 100,000 person-years) than the 2nd year (3.4 cases per 100,000 person-years). The incidence was similar among metropolitan, non-metropolitan, and rural counties. Significantly more cases occurred during the holiday months (October–December). The median age of victims was 4.1 months. Both victims and perpetrators were more commonly male (58.4% of victims, and 70% of identified perpetrators). Compared with the entire population of Pennsylvania parents, the parents of the study cohort were more likely to be younger, less educated, and unmarried. Both mothers and fathers were more often African-American and fathers more often Hispanic. Finally, mothers more often smoked during pregnancy, sought prenatal care later in the pregnancy, and delivered low birth weight infants.

Conclusions

This population-based study of abusive head injuries throughout an entire state adds significantly to the growing knowledge about this condition. The results suggests that families of infants with abusive head injuries have significantly different demographic features compared with the general population, although which of these variables is independently significant cannot be ascertained from this study and require further investigation.

Abbreviations used in this paper: AHT = abusive head trauma; CI = confidence interval; ICD-10 = International Classification of Diseases, 10th Revision; OCYF = Office of Children, Youth and Families.

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Contributor Notes

Address correspondence to: Mark S. Dias, M.D., Department of Neurosurgery H110, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania 17033. email: mdias@psu.edu.

Current address for Dr. Kesler: Department of Neurosurgery, Strong Memorial Hospital, Rochester, New York.

  • 1

    American Academy of Pediatrics Committee on Child Abuse and Neglect: Shaken baby syndrome: rotational cranial injuries—technical report. Pediatrics 108:206210, 2001

    • Search Google Scholar
    • Export Citation
  • 2

    Anonymous: Shaken baby syndrome: inflicted cerebral trauma. Committee on Child Abuse and Neglect, 1993–1994. Pediatrics 92:872875, 1993

    • Search Google Scholar
    • Export Citation
  • 3

    Barlow KM, & Minns RA: Annual incidence of shaken impact syndrome in young children. Lancet 356:15711572, 2000

  • 4

    Cobley C, & Sanders T: Shaken baby syndrome: child protection issues when children sustain a subdural hemorrhage. J Social Welfare Fam Law 25:101119, 2003

    • Search Google Scholar
    • Export Citation
  • 5

    Cobley C, , Sanders T, & Wheeler P: Prosecuting cases of suspected shaken baby syndrome—a review of current issues. Crim LR 93:102105, 2003

    • Search Google Scholar
    • Export Citation
  • 6

    Daly SE, & Connor SM: Seasonal variations in the incidence of suspected shaken baby syndrome. Int J Trauma Nurs 7:124128, 2001

  • 7

    Dias MS, , Backstrom J, , Falk M, & Li V: Serial radiography in the infant shaken impact syndrome. Pediatr Neurosurg 29:7785, 1998

  • 8

    Dias MS, , Smith K, , DeGuehery K, , Mazur P, , Li V, & Shaffer ML: Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. Pediatrics 115:e470e477, 2005

    • Search Google Scholar
    • Export Citation
  • 9

    Duhaime AC, , Christian C, , Moss E, & Seidel T: Long-term outcome in infants with the shaking impact syndrome. Pediatr Neurosurg 24:292298, 1996

    • Search Google Scholar
    • Export Citation
  • 10

    Duhaime AC, , Christian CW, , Rorke LB, & Zimmerman RA: Non-accidental head injury in infants—the “shaken baby syndrome. New Engl J Med 338:18221829, 1998

    • Search Google Scholar
    • Export Citation
  • 11

    Ellingson KD, , Leventhal JM, & Weiss HB: Using hospital discharge data to track influcited traumatic brain injury. Am J Prevent Med in press

    • Search Google Scholar
    • Export Citation
  • 12

    Ennis E, & Henry M: A review of social factors in the investigation and assessment of non-accidental head injury to children. Pediatr Rehab 7:205214, 2004

    • Search Google Scholar
    • Export Citation
  • 13

    Goldstein B, , Kelly MM, , Bruton D, & Cox C: Inflicted versus accidental head injury in critically ill children. Crit Care Med 21:13281332, 1993

    • Search Google Scholar
    • Export Citation
  • 14

    Hadley MN, , Sonntag VKH, , Rekate HL, & Murphy A: The infant whiplash-shake injury syndrome: a clinical and pathological study. Neurosurgery 24:536540, 1989

    • Search Google Scholar
    • Export Citation
  • 15

    Jenny C, , Hymel KP, , Ritzen A, , Reinert SE, & Hay TC: Analysis of missed cases of abusive head trauma. JAMA 281:621626, 1999

  • 16

    Keenan HT, , Runyan DK, , Marshall SW, , Nocera MA, , Merten DF, & Sinal SH: A population-based study of inflicted traumatic brain injury in young children. JAMA 290:621626, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Kravitz H, , Driessen G, , Gomberg R, & Korach A: Accidental falls from elevated surfaces in infants from birth to one year of age. Pediatrics 44:Suppl 869876, 1969

    • Search Google Scholar
    • Export Citation
  • 18

    Sinal SH, & Ball MR: Head trauma due to child abuse: serial computerized tomography in diagnosis and management. South Med J 80:15051512, 1987

    • Search Google Scholar
    • Export Citation
  • 19

    Starling SP, , Holden JR, & Jenny C: Abusive head trauma: the relationship of perpetrators to their victims. Pediatrics 95:259262, 1995

  • 20

    Starling SP, , Patel S, , Burke BL, , Sirotnak AP, , Stronks S, & Rosquist P: Analysis of perpetrator admissions to inflicted traumatic brain injury in children. Arch Pediatr Adolesc Med 158:454458, 2004

    • Search Google Scholar
    • Export Citation
  • 21

    Thomas NJ, , Shaffer ML, , Rzucidlo S, , Shirk B, & Dias MS: Temporal factors and the incidence of physical abuse in young children: decreased nonaccidental trauma during Child Abuse Prevention Month. J Pediatr Surg 42:17351739, 2007

    • Search Google Scholar
    • Export Citation
  • 22

    Zimmerman RA, , Bilaniuk LT, , Gennarelli T, , Bruce D, , Dolinskas C, & Uzzell B: Cranial computed tomography in diagnosis and management of acute head trauma. AJR Am J Roentgenol 131:2734, 1978

    • Search Google Scholar
    • Export Citation

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