http://informahealthcare.com/bij ISSN: 0269-9052 (print), 1362-301X (electronic) Brain Inj, Early Online: 1–7 ! 2013 Informa UK Ltd. DOI: 10.3109/02699052.2013.831126 Paediatric patients with abusive head trauma treated in US Emergency Departments, 2006–2009 Joe Xiang 1,2 , Junxin Shi 1 , Krista Kurz Wheeler 1 , Keith Owen Yeates 1,3 , H. Gerry Taylor 2,4 , & Gary A. Smith 1,3 1 Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA, 2 Case Western Reserve University, Cleveland, OH, USA, 3 The Ohio State University College of Medicine, Columbus, OH, USA, and 4 Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, OH, USA Abstract Objective: To study characteristics and outcomes of paediatric patients with abusive head trauma (AHT) treated in emergency departments. Methods: Nationwide Emergency Department Sample (NEDS) data were analysed. The CDC recommended AHT definition was used to classify children  4 years with head trauma into AHT and non-AHT groups. Outcomes were compared between patients with AHT and patients with non-AHT. Logistic models were fitted to identify risk factors. Results: An estimated 10 773 paediatric patients with AHT were treated in EDs in 2006–2009. The average annual rate was 12.83 per 100 000 for children  4 years. Children 51 year of age accounted for most AHT cases (60.6%) and males had a significantly higher AHT rate than females. Medicaid was the primary payer for 66.1% of AHT injuries and 40.3% of non-AHT injuries. The case mortality rate was 53.9 (95% CI ¼ 41.0–66.7) per 1000 patients with AHT compared with 1.6 (95% CI ¼ 1.4–1.9) per 1000 patients with non-AHT. Conclusions: Child caregivers should be educated about the serious consequences of AHT and proper techniques for caring for infants. Unbiased and accurate documentation of AHT by physicians and medical coders is crucial for monitoring AHT injuries. Abbreviations: AHT, Abusive Head Trauma; CI, Confidence Interval; ED, Emergency Department; ICD-9-CM, International Classification of Disease Ninth Revision, Clinical Modification; TBI, Traumatic Brain Injury Keywords Abuse, children, emergency department, head trauma, traumatic brain injury History Received 8 February 2013 Revised 4 June 2013 Accepted 30 July 2013 Published online 3 October 2013 Introduction Abusive head trauma (AHT) is a serious injury resulting from assault on young children leading to injuries to the brain [1]. These injuries can have a severe impact on neurological development and can cause death among young children [2–6]. Only 10–15% of patients with AHT have little to no impairment or disability as a result of their injury [7–10]. Estimates indicate that 20–30% of head trauma-related deaths among children younger than 2 years old are caused by abuse [11]. Although previous research has examined AHT in detail [12, 13], many studies have been limited by the lack of a standardized case definition [14]. Depending on the case definition or ICD-9-CM codes used to identify AHT, results from studies vary considerably when compared with each other [14, 15]. The lack of a standardized case definition also limits the ability of the public health community and medical professionals to gauge and monitor the magnitude of AHT and to identify those children at high risk [16]. To address this issue, the Centers for Disease Control and Prevention (CDC) convened an expert panel of paediatri- cians, child maltreatment experts and abusive head trauma experts in 2008 to develop a standardized operational case definition of AHT for public health surveillance and research using administrative data [16]. This standardized definition has been used in the US to analyse AHT deaths based on national vital statistics data [5] and hospitalized non-fatal AHT based on Nationwide Inpatient Sample (NIS) data [11]. This recommended definition has not yet been applied to examine the burden and outcomes of AHT injuries treated in a national sample of US EDs, although it is a stated applicable use of the recommended definition [16]. To address this gap in knowledge, this study applied the CDC case definition of AHT to estimate the national rate of AHT injuries among children 4 years old treated in EDs from 2006–2009. This study also compared characteristics and outcomes of patients with AHT and patients with non-AHT and used logistic models to evaluate risk factors. Correspondence: Gary A. Smith, MD, DrPH, Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA. Tel: 614-355-5850. Email: gary.smith@nationwidechildrens.org Brain Inj Downloaded from informahealthcare.com by Ohio State University Libraries on 10/08/13 For personal use only.