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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

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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.

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).

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.

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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