@article{1359b9abb4b944adbb449f1eeed0e654,
title = "Paediatric patients with abusive head trauma treated in US emergency departments, 2006-2009",
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 < 1 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=41.0-66.7) per 1000 patients with AHT compared with 1.6 (95\% CI=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.",
keywords = "Abuse, Children, Emergency department, Head trauma, Traumatic brain injury",
author = "Joe Xiang and Junxin Shi and Wheeler, \{Krista Kurz\} and Yeates, \{Keith Owen\} and Taylor, \{H. Gerry\} and Smith, \{Gary A.\}",
note = "Funding Information: This study used the 2006{\textendash}2009 Nationwide Emergency Department Sample (NEDS) database. NEDS is part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). NEDS was first created in 2006 by AHRQ and the 2009 NEDS was the most current dataset available when this study was conducted. The NEDS is the largest all-payer ED database publicly available in the US and contains \textasciitilde{}25+ million ED visits from more than 900 hospitals each year from 2006{\textendash}2009 [17]. The NEDS provides a 20\% stratified probability sample of all US community, non-rehabilitation hospital EDs. The database generates estimates on almost 130 million ED visits yearly and includes more than 100 clinical and non-clinical variables for each ED visit. NEDS provides up to 15 International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes and up to four External-Cause-of-Injury codes (E-codes) per ED discharge. Weight and sampling variables are provided for calculating national estimates and confidence intervals of the estimates. Although NEDS provides ED discharge data for all ages, the analyses here are limited to discharges of patients ≤4 years old with head trauma. This age range is considered the highest risk age group for AHT [1, 16, 18]. The NEDS database is de-identified publicly available data; thus, this study was reviewed and considered exempt by the Institutional Review Board of the Research Institute at Nationwide Children{\textquoteright}s Hospital.",
year = "2013",
doi = "10.3109/02699052.2013.831126",
language = "English",
volume = "27",
pages = "1555--1561",
journal = "Brain Injury",
issn = "0269-9052",
number = "13-14",
}