Abusive head trauma injuries linked to socioeconomic status, age and gender

(Medical Xpress)—A new study estimates that more than seven children under the age of five with abusive head trauma were treated each day in U.S. emergency departments between 2006 and 2009. Abusive head trauma is a serious injury resulting from an assault on a young child leading to injuries on the brain, and is the leading cause of death in child abuse cases in the U.S.

The study, led by researchers in the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital, found that children under the age of one from families with are at highest risk from abusive head injury. According to the study published in Brain Injury in October, households with a lower median income in their zip code had a higher frequency of abusive head trauma. Abusive head trauma patients were also more likely to be enrolled in Medicaid.

The study's authors hypothesize that households with lower incomes are under more stress than households with higher incomes and this stress increases the risk of physically aggressive responses to child behaviors. It could also reflect a bias in the diagnosis and reporting of abuse by medical professionals.

"The data suggests the need for prevention efforts focusing on educating child caregivers about the serious consequence of abusive head trauma and proper practice in caring for infants, including to never shake a baby," said Krista Wheeler, a senior research associate with the Center for Injury Research and Policy at Nationwide Children's and an author of the study. "Study findings indicate the need to increase strategies to prevent head trauma among children, including parent education in the newborn nursery regarding how to appropriately handle infant crying, formal home visiting programs and parent support groups."

Comparing abusive head trauma injuries to head injuries not caused by abuse, patients with abusive head trauma were significantly younger. Abusive head trauma patients have a significantly higher mortality rate and worse outcomes than with other head traumas that are not linked to abuse. Previous studies have shown that 85 to 90 percent of patients with abusive head trauma had impairment or disability as a result of their injury.

In 2008, The Centers for Disease Control and Prevention (CDC) standardized the way that abusive head trauma was defined to allow for better public health surveillance and understanding of abusive patterns, and this is the first study to apply this definition to nationally representative emergency department data.

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