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Hot Topic 4: Cost of Abusive head trauma (AHT)

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HOT TOPIC: Pediatric Abusive Head Trauma

Review: (R. Miller) Most research on pediatric abusive head trauma focuses on management and clinical presentation. This study reviews cost, incidence and seasonal trends, and extent of injuries.

Title: Abusive head trauma: an epidemiological and cost analysis

Journal of Neurosurgery: Pediatrics Nov 2016 / Vol. 18 / No. 5 / Pages 542-549

Authors: Scott Boop, MPH Mary Axente, NP, Blakely Weatherford, NP, and Paul Klimo Jr., MD, MPH

Author Affiliations: College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Neuroscience Institute, Le Bonheur Children's Hospital;3Department of Neurosurgery, University of Tennessee Health Science Center; and Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee

Downloaded From:
http://thejns.org/doi/abs/10.3171/2016.1.PEDS15583?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Why This Article is Relevant or Important: Abusive head trauma is a leading cause of death from abuse. This article reviews cost and a better understanding of the population effected if possible.

Very Brief Review:

Background: Research on pediatric abusive head trauma has focused on clinical presentation and treatment. The small study attempts to review a one institution's practice from a public health perspective to gain a better understanding of the local population affected, determine overall incidence and seasonal incidences, while providing details on the initial hospitalization, including extent of injuries, neurosurgical interventions, and hospital charges.

Methods:
All incidents of AHT related to patients who presented to a pediatric hospital from 2009 through 2014 were identified. AHT was defined as skull fracture or intracranial hemorrhage in a child under the age of 5 years with a suspicious mechanism of injury or evidence of other non-accidental injuries, such as retinal hemorrhages, old or new fractures, or soft-tissue bruising. Injuries were categorized as Grade I (skull fracture only), Grade II (intracranial hemorrhage or edema not requiring surgical intervention), or Grade III (intracranial hemorrhage requiring intervention or death due to brain injury).

Results:
Two hundred thirteen AHT cases were identified. The demographics of the study population are similar to those reported in the literature: the majority of the patients involved were 6 months of age or younger (55%), male (61%), African American (47%), and publicly insured (82%). One hundred one neurosurgical procedures were performed in 58 children. The annual incidence rate rose from 2009 (19.6 cases per 100,000 in the population under 5 years of age) to 2014 (47.4 cases per 100,000) and showed seasonal peaks in January, July, and October (6-year average single-month incidence, respectively, 24.7, 21.7, and 24.7 per 100,000). The total hospital charges were $13,014,584, with a median cost of $27,939. Treatment costs for children who required surgical intervention (i.e., those with Grade III) were up to 10 times those of children with less severe injuries.

Conclusion:
In this study, the majority of the patients was infants, male, and lower socioeconomic status. The incidence of AHT is increasing and hospital charges are substantial but variable. The authors introduce a simple 3-tiered injury classification scheme that adequately stratifies length of hospital stay and cost.

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