Parent Education by Maternity Nurses and Prevention of Abusive Head Trauma

Altman, Robin; Canter, Jennifer; Patrick, Patricia A.; Daley, Nancy; Butt, Neelofar K.; Brand, Donald A.

doi:10.1542/peds.2010-3260

Cited by 87 publications

(84 citation statements)

References 19 publications

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“…Kesler et al and Altman et al reported a greater concentration of AHT prevention programs in the northern states. 1,15 As noted in Shanahan et al, it is also possible that differences in ICD-9-CM coding practices affect the rates reported by authors using administrative databases. 25 In a preliminary exploration of the KID database, we found that northern states were much more likely to document SBS than western states (54.8% vs 35.0%, p = 0.004).…”

Section: Discussionmentioning

confidence: 97%

Outcomes and factors associated with infant abusive head trauma in the US

Nuño

Pelissier

Varshneya

et al. 2015

PED

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OBJECT Head trauma is the leading cause of death in abused children, particularly prior to the age of 2 years. An awareness of factors associated with this condition as well as with a higher risk of mortality is important to improve outcomes and prevent the occurrence of these events. The objective of this study was to evaluate outcomes and factors associated with poor outcomes in infants with diagnosed abusive head trauma (AHT). Patient characteristics, socioeconomic factors, and secondary conditions such as retinal bleeding, contusion, and fractures were considered. METHODS Data were obtained from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. From the Kids’ Inpatient Database (KID) sample, the authors identified infants no older than 23 months who had been diagnosed with AHT in 2000, 2003, 2006, and 2009. All statistical analyses were conducted in SAS 9.2. Descriptive statistics were provided, and multivariate logistic regression models were applied to evaluate factors associated with mortality and nonroutine discharge. RESULTS A total of 5195 infants were analyzed in this study. Most infants (85.5%) had ages ranging between 0 and 11 months and were male (61.6%). Overall mortality was 10.8%, with a rate of 9.8% in the 0- to 11-month-old cohort and 16.5% in the 12- to 23-month-olds (p = 0.0003). The overall nonroutine discharge rate of 25.6% increased significantly from 23.3% to 39.0% with increasing age (0–11 vs 12–23 months of age, p < 0.0001). Assuming a multivariate model that adjusted for multiple confounders, the authors found that older infants (12–23 vs 0–11 months, OR 1.81, 95% CI 1.18–2.77) with a secondary diagnosis of retinal bleeding (OR 2.85, 95% CI 2.02–4.00) or shaken baby syndrome (OR 2.09, 95% CI 1.48–2.94) had an increased risk of mortality; these factors were similarly associated with an increased odds of a nonroutine discharge. A higher income ($30,001–$35,000 vs $1–$24,999) was associated with a reduction in the odds of mortality (OR 0.46, 95% CI 0.29–0.72). In the subset of cases (1695 [32.6%]) that specified the perpetrator involved in infant injury, the authors found that the father, stepfather, or boyfriend was most frequently reported (67.4%). A trend for a higher AHT incidence was documented in the early ages (peak at 2 months) compared with older ages. CONCLUSIONS Despite the higher incidence of AHT among infants during the earlier months of life, higher mortality was documented in the 12- to 23-month-olds. Retinal bleeding and shaken baby syndrome were secondary diagnoses associated with higher mortality and nonroutine discharge. Males (67.4%) were overwhelmingly documented as the perpetrators involved in the injury of these infants.

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Section: Discussionmentioning

confidence: 97%

Outcomes and factors associated with infant abusive head trauma in the US

Nuño

Pelissier

Varshneya

et al. 2015

PED

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“…We know of 2 studies, both of which were conducted in the Northeast, that reported reductions in AHT cases ranging from 47% to 75% as a result of AHT prevention programs. 6,22 It is also possible that ICD-9-CM coding practices differ between regions, which would affect the rates found in the current analysis. Finally, there may be other external influences on AHT rates, such as the economy or unemployment, that differ between regions.…”

Section: Discussionmentioning

confidence: 99%

National, Regional, and State Abusive Head Trauma: Application of the CDC Algorithm

et al. 2013

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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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“…The principal program constituents were the delivery by nurses of information about the dangers of violent infant shaking, asking parents to watch a videotape discussing the dangers of shaking and ways to handle persistent crying, educational posters on the wards, and voluntary signing of a commitment statement affirming receipt and understanding of the materials. A small replication using similar materials reported a 75% reduction in incidence (122).…”

Section: Window Of Opportunity For Preventionmentioning

confidence: 96%

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

Barr

2012

Proc. Natl. Acad. Sci. U.S.A.

101

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Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant-caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally.infant development | colic | excessive crying | child maltreatment | parenting A busive head trauma (AHT), also known more commonly as shaken baby syndrome (SBS), is a devastating and potentially lethal form of infant physical abuse (1). The outcomes are grim. In recognized cases, AHT typically results in death or extremely damaging injuries. About 18-25% of babies who are shaken and hospitalized die (2-7). As many as 80% of survivors have significant lifelong brain injuries (3,8,9). Although currently under study, there are no published estimates of lifetime costs per victim specific to AHT. However, the conservative estimated lifetime costs per victim is $210,012 for nonfatal child maltreatment or $1,272,900 for a death from child maltreatment (in 2010 dollars) for a total estimated economic burdern in the US for one year of $124 billion (10). Given its relative severity compared to other forms of maltreatment, these per victim estimates are likely to underestimate the lifetime costs for AHT victims. Of course, the "costs" go far beyond financial considerations, and include the destruction of families and the failure of society's moral obligation to protect defenseless infants.Preventing child maltreatment of any kind is challenging (11) because of the lack of specific stimuli for abuse, the density and difficulties of modifying risk factors in which families of maltreated children are often embedded, and the challenges of getting appropriate supports to the families. However, the convergence of our increasing un...

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Parent Education by Maternity Nurses and Prevention of Abusive Head Trauma

Cited by 87 publications

References 19 publications

Outcomes and factors associated with infant abusive head trauma in the US

Outcomes and factors associated with infant abusive head trauma in the US

National, Regional, and State Abusive Head Trauma: Application of the CDC Algorithm

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

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