Disparities In Incidence And Case Fatality Rates Of Abusive Head Trauma
*Miriam Nuno1, Courtney D Shelley1, Beatrice Ugiliweneza2, Julia N Magaņa3
1UC Davis, Davis, CA;2University of Louisville, Louisville, KY;3UC Davis Medical Center, Sacramento, CA
Background: Incidence of abusive head trauma (AHT) is greater in <1 year-olds. Little is known about the risk of AHT in older toddlers and there is limited evidence about potential disparities in incidence and case fatality rates. We aimed to evaluate differences in AHT incidence and case fatality by age, race, sex, and geographical region. Methods: We conducted a retrospective study of AHT hospitalizations in 2000, 2003, 2006, 2009, and 2012 from the Kid's Inpatient Claims Database (KID). Differences in incidence and case fatality were evaluated via survey-weighted chi-square tests. Results: Annual incidence was highest in children <1 year (27.46), followed by 1-2 (4.44), 3-4 (3.27), 3-5 (0.71) year-olds (p<0.0001). Disparities in incidence by race were captured (Figure). Boys had higher incidence than girls (33.38, 21.31) and the Midwest (37.23) had greatest incidence. Annual case fatality rate in <1 year-olds was 0.10 compared to 0.15 in 1-2 years, 0.23 in 2-3 years, and 0.20 in 3-5 year-olds. Boys and girls had similar case fatality. Among children <1 year, Northeast hospitals had lower case fatality rates (0.08) than Midwest (0.09), South (0.12), and West (0.10). Conclusions: Children <1 year had greater incidence, yet older toddlers with the lowest incidence had the greatest case fatality. Providers have the opportunity to improve awareness of AHT in older toddlers, a cohort of children often perceived as low-risk for AHT.
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