Differences in Incidence and Case Fatality of Abusive Head Trauma

Background: Abusive head trauma (AHT) in children older than 1 and younger than 5 years old is thought uncommon and rarely studied. Objective: This study estimates national incidence and case fatality rate of abusive head trauma (AHT), and evaluates differences by age, sex, race, and region, with a focus on children of 2-4 years. Participants and setting: Hospital discharges were extracted from The Healthcare Cost and Utilization Project's Kids’ Inpatient Database from 2000, 2003, 2006, 2009, and 2012 using the CDC's narrow definition of AHT. Methods: Survey-weighted chi-square tests were used to assess differences in incidence and case fatality rates. Results: The average annual incidence per 100,000 children was highest in <1 year-olds (27), followed by age 1 (4), age 2 (3), and age 3-4 (1). Average annual incidence varied significantly by sex (p = 0.0001), race (p < 0.0001), and region (p = 0.0002) within each age category. The average annual case fatality rate increased significantly with age, with a rate of 0.10 among children age <1 year, 0.15 for age 1, 0.23 for age 2, and 0.20 for age 3-4 years. The average annual case fatality rate was higher in the South (0.12) than West (0.10), Midwest (0.09), and Northeast (0.08) among children <1 year of age. Conclusions: Black and Hispanic children and hospitals in the Midwest experienced higher incidence of AHT than White children and Northeast hospitals, respectively, especially in cases <1 year of age. Case fatality rates increased significantly with age, and the South experienced the highest rates for infants <1 year.