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Abusive Head Trauma

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A Practical Guide to the Evaluation of Child Physical Abuse and Neglect

Abstract

AHT is any injury to the skull or intracranial contents of an infant or child younger than 5 years caused by inflicted blunt impact, violent shaking, or both (Parks et al., Pediatric abusive head trauma: recommended definitions for public health surveillance and research. Centers for Disease Control and Prevention. http://www.ncdsv.org/images/CDC_PediatricAbusiveHeadTraumaRecommendedDefinitionsPHSurvAndResearch_2012.pdf. Accessed July 2017, 2012). The American Academy of Pediatrics (AAP) has recommended that the term shaken baby syndrome be replaced in medical records with the broader term abusive head trauma, which allows for consideration of multiple mechanisms of injury in any child (Christian and Block, Pediatrics 123(5):1409–1411, 2009).

Abusive head trauma (AHT) is the most common cause of death in abused children, especially those under 2 years of age (Nuño et al., J Neurosurg Pediat 16(5):515–522, 2015; Niederkrotenthaler et al., Child Abuse Negl 37(7):446–455, 2013; Yu et al., J Pediatr Surg (epub ahead of print). Accessed 04-03-2018, 2018). The incidence of AHT in the first 2 years of life has been shown to be 16% to 33% per 100,000 infants per year; this is felt to be an underestimate (Keenan and Runyan 2003; Palusci and Covington, Child Abuse Negl 38(1): 25–36, 2014; Narang and Clarke, J Child Neurol 29(12):1747–1756, 2014). A recent retrospective analysis of hospitalizations for AHT revealed national rates of 39.8/100,000 children under 1 year and 6.8/100,000 children 1–2 years old (Niederkrotenthaler et al., Child Abuse Negl 37(7):446–455, 2013).

The estimated annual cost of US hospital visits for the initial evaluation and management of AHT is $69.6 million/year (Peterson et al., Child Maltreatment 20(3):162–169, 2015). Medical costs may continue for years following diagnosis and include inpatient, outpatient, and medication costs (Peterson et al., Pediatrics 134(1):91–99, 2014).

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Authors and Affiliations

  1. Department of Emergency Medicine, UT Health/McGovern Medical School, Houston, TX, USA

    Donna Mendez

  2. Texas Children’s Hospital, Houston, TX, USA

    Erin E. Endom

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  1. Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA

    Angelo P. Giardino

  2. Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Michelle A. Lyn

  3. Department of Integrative Care, School of Nursing at Houston, University of Texas, Houston, TX, USA

    Eileen R. Giardino

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Mendez, D., Endom, E.E. (2019). Abusive Head Trauma. In: Giardino, A., Lyn, M., Giardino, E. (eds) A Practical Guide to the Evaluation of Child Physical Abuse and Neglect. Springer, Cham. https://doi.org/10.1007/978-3-030-00635-8_6

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