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  • Abusive Head Trauma in Young Children

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, March 2022

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    Shah et al. set out to assess the preva­lence of abusive head trauma (AHT) in young children and to identify factors associated with mortality. They found that the incidence of AHT decreased by 6.7% each year during the 13-year period of their study, while mortality rates remained constant. In addition, they found that health care disparities may play a role in treatment of AHT.

    For this retrospective cross-sectional study, the researchers used the Nation­wide Emergency Department Sample database to identify all emergency department (ED) visits in the United States for patients younger than age 5 years with a primary diagnosis of AHT. The study period ran from Jan. 1, 2006, to Dec. 31, 2018. Main out­come measures included prevalence, demographic characteristics, clinical characteristics, mortality, and economic burden associated with AHT.

    During the years covered in this study, an estimated 12,287 ED visits took place for AHT in young children. All told, 57.3% (n = 7,046) of the chil­dren were younger than 1 year of age, 59.2% (n = 7,268) were male, and 70% (n = 8.585) were covered by Medicaid.

    The estimated number of AHT cases decreased by 672 overall during the study period, with a yearly decrease of 6.7%. With regard to mortality, 25 (.2%) of the children died in the ED, and 646 (5.3%) died during the course of their hospitalization. Children who were older than 1 year of age, from lower-income zip codes, and from Midwestern states had higher mortality rates. Clinical findings associated with higher mortal­ity included orbital and skull fractures; retinal, intracranial, subarachnoid, and subdural hemorrhages; cerebral edema; and hypoxic ischemic brain injury. Of the ophthalmic findings, retinal hemorrhages and orbital fracture were associated with higher mortality.

    The mean ED charge per patient throughout the study period was $2,758, increasing from a mean of $2,081 in 2006 to a mean of $4,706 in 2018. The total ED charge for all patients was $26.5 million.

    Given these findings, the researchers suggested that public health efforts designed to prevent AHT should be targeted toward low-income areas and the Midwest.

    The original article can be found here.