WHAT'S KNOWN ON THIS SUBJECT: Abusive head trauma (AHT) is a rare phenomenon that results in devastating injuries to children. It is necessary to analyze large samples to examine changes in rates over time. WHAT THIS STUDY ADDS:This is the first study to examine rates of AHT at the national, regional, and state level. The results provide a more detailed description of AHT trends than has been previously available. abstract OBJECTIVE: To examine national, regional, and state abusive head trauma (AHT) trends using child hospital discharge data by applying a new coding algorithm developed by the Centers for Disease Control and Prevention (CDC). METHODS:Data from 4 waves of the Kids' Inpatient Database and annual discharge data from North Carolina were used to determine trends in AHT incidence among children ,1 year of age between 2000 and 2009. National, regional, and state incidence rates were calculated. Poisson regression analyses were used to examine national, regional, and state AHT trends. RESULTS:The CDC narrow and broad algorithms identified 5437 and 6317 cases, respectively, in the 4 years of KID weighted data. This yielded average annual incidences of 33.4 and 38.8 cases per 100 000 children ,1 year of age. There was no statistically significant change in national rates. There were variations by region of the country, with significantly different trends in the Midwest and West. State data for North Carolina showed wide annual variation in rates, with no significant trend. CONCLUSIONS:The new coding algorithm resulted in the highest AHT rates reported to date. At the same time, we found large but statistically insignificant annual variations in AHT rates in 1 large state. This suggests that caution should be used in interpreting AHT trends and attributing changes in rates as being caused by changes in policies, programs, or the economy. Pediatrics 2013;132:e1546-e1553 AUTHORS:

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Currently, little is known about patterns of co-occurring risk and protective factors among young children. Understanding variations in co-occurring risk and protective factors among children in Alaska is important as experiences of collective trauma may contribute to differences in the intersection of risk and protective factors between Alaska Native/American Indian (AN/AI) and non-Native children. Using data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of the 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System survey and administrative data sources, and the 2012-2014 Childhood Understanding Behaviors Survey, we conducted latent class analysis to identify classes of AN/AI (N=593) and non-Native (N=1,018) children in terms of seven risk factors (poverty, maternal

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