Long-term impact of abusive head trauma in young children

Miriam A Nuno, Beatrice Ugiliweneza, Veronica Zepeda, Jamie Anderson, Kevin Coulter, Julia Magana, Doniel Drazin, Maxwell Boakye

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Abusive head trauma is the leading cause of physical abuse deaths in children under the age of 5 and is associated with severe long-lasting health problems and developmental disabilities. This study evaluates the long-term impact of AHT and identifies factors associated with poor long-term outcomes (LTOs). Methods: We used the Truven Health MarketScan Research Claims Database (2000–2015) to identify children diagnosed with AHT and follow them up until they turn 5. We identified the incidence of behavioral disorders, communication deficits, developmental delays, epilepsy, learning disorders, motor deficits, and visual impairment as our primary outcomes. Results: The incidence of any disability was 72% (676/940) at 5 years post-injury. The rate of developmental delays was 47%, followed by 42% learning disorders, and 36% epilepsy. Additional disabilities included motor deficits (34%), behavioral disorders (30%), visual impairment (30%), and communication deficits (11%). Children covered by Medicaid experienced significantly greater long-term disability than cases with private insurance. In a propensity-matched cohort that differ primarily by insurance, the risk of behavioral disorders (RD 36%), learning disorders (RD 30%), developmental delays (RD 30%), epilepsy (RD 18%), and visual impairment (RD 12%) was significantly higher in children with Medicaid than kids with private insurance. Conclusion: AHT is associated with a significant long-term disability (72%). Children insured by Medicaid have a disproportionally higher risk of long-term disability. Efforts to identify and reduce barriers to health care access for children enrolled in Medicaid are critical for the improvement of outcomes and quality of life.

Original languageEnglish (US)
JournalChild Abuse and Neglect
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Craniocerebral Trauma
Medicaid
Learning Disorders
Vision Disorders
Insurance
Epilepsy
Communication Disorders
Developmental Disabilities
Health Services Accessibility
Incidence
Health
Communication
Quality of Life
Databases
Wounds and Injuries
Research

Keywords

  • Abusive head trauma (AHT)
  • Injury severity score (ICISS)
  • Long-term outcomes
  • Propensity matched cohort
  • Risk difference (RD)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Long-term impact of abusive head trauma in young children. / Nuno, Miriam A; Ugiliweneza, Beatrice; Zepeda, Veronica; Anderson, Jamie; Coulter, Kevin; Magana, Julia; Drazin, Doniel; Boakye, Maxwell.

In: Child Abuse and Neglect, 01.01.2018.

Research output: Contribution to journalArticle

Nuno, Miriam A ; Ugiliweneza, Beatrice ; Zepeda, Veronica ; Anderson, Jamie ; Coulter, Kevin ; Magana, Julia ; Drazin, Doniel ; Boakye, Maxwell. / Long-term impact of abusive head trauma in young children. In: Child Abuse and Neglect. 2018.
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AB - Objective: Abusive head trauma is the leading cause of physical abuse deaths in children under the age of 5 and is associated with severe long-lasting health problems and developmental disabilities. This study evaluates the long-term impact of AHT and identifies factors associated with poor long-term outcomes (LTOs). Methods: We used the Truven Health MarketScan Research Claims Database (2000–2015) to identify children diagnosed with AHT and follow them up until they turn 5. We identified the incidence of behavioral disorders, communication deficits, developmental delays, epilepsy, learning disorders, motor deficits, and visual impairment as our primary outcomes. Results: The incidence of any disability was 72% (676/940) at 5 years post-injury. The rate of developmental delays was 47%, followed by 42% learning disorders, and 36% epilepsy. Additional disabilities included motor deficits (34%), behavioral disorders (30%), visual impairment (30%), and communication deficits (11%). Children covered by Medicaid experienced significantly greater long-term disability than cases with private insurance. In a propensity-matched cohort that differ primarily by insurance, the risk of behavioral disorders (RD 36%), learning disorders (RD 30%), developmental delays (RD 30%), epilepsy (RD 18%), and visual impairment (RD 12%) was significantly higher in children with Medicaid than kids with private insurance. Conclusion: AHT is associated with a significant long-term disability (72%). Children insured by Medicaid have a disproportionally higher risk of long-term disability. Efforts to identify and reduce barriers to health care access for children enrolled in Medicaid are critical for the improvement of outcomes and quality of life.

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