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Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team
  1. Patrick Kelly1,2,
  2. Simon John3,
  3. Andrea L Vincent4,5,
  4. Peter Reed6
  1. 1Te Puaruruhau (Child Protection Team), Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
  2. 2Department of Paediatrics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  3. 3Department of Neurosurgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
  4. 4Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
  5. 5Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  6. 6Children's Research Centre, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
  1. Correspondence to Dr Patrick Kelly, Te Puaruruhau (Child Protection), Starship Children's Hospital, Park Road, Private Bag 92024, Auckland 1, New Zealand; patrickk{at}adhb.govt.nz

Abstract

Aim To describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand.

Methods Comparative review of demographics, histories, injuries, investigations and diagnostic outcomes for referrals under 15 years old from 1991 to 2010.

Results Records were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%).

Conclusions The striking increase in referrals for AHT probably represents increasing incidence. The decision to refer a hospitalised child with a head injury for assessment for possible AHT should not be influenced by socio-economic status or ethnicity. Children over 2 years old hospitalised for AHT are usually injured by mechanisms involving impact and should be considered at high risk of death.

  • Child Abuse
  • Multidisciplinary team-care
  • Race and Health

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