204286 Inflicted Traumatic Brain Injury (ITBI) in Children Older than 1yr of age: An Emerging Concern

Sunday, November 8, 2009

Rachel Pardes Berger, MD, MPH , Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Janet Fromkin, MD , Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Patrick Kochanek, MD , Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA
Janet Squires, MD , Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Thomas J. Songer, PhD, MSc , Center for Injury Research & Control, University of Pittsburgh, Pittsburgh, PA
Mark Dias, MD , Department of Neurosurgery, Penn State Milton Hershey Medical Center, Hershey, PA
Monique Higginbotham, MD , Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Anthony Fabio, PhD , Department of Neurosurgery, Center for Injury Research and Control, University of Pittsburgh, Pittsburgh, PA
ITBI is the leading cause of severe TBI in infants. The incidence of ITBI decreases significantly after 1yr of age. After 2yr of age, ITBI is thought to be so rare that a case-series of four children was recently published. The Children's Hospital of Pittsburgh (CHP) Child Protection Team (CPT) has noted an increase in ITBI in children >1yr over the past several years.

We reviewed all cases of ITBI diagnosed by CHP CPT from 2005-2008. Data about ITBI cases in Pennsylvania were available from ChildLine, the state system for child abuse tracking. Cases of ITBI at CHP from 1995-1998 served as a baseline.

At CHP from 2005-2008, 36%(27/76) of children were >1yr; 9%(7/76) were >2yr. In PA, 24%(49/206) were >1yr; 8%(17/206) were >2yr. The proportion of children >1yr with ITBI in PA increased steadily from 15% to 25% from 2005 to 2008 and mortality was higher in children >1yr vs. those <1yr [27% vs. 10% (p = 0.008)]. From 1995-1998, only 11% (5/44) of CHP ITBI were >1yr. None were >2yr.

These data suggest an increase in the number and proportion of older children with ITBI and higher mortality in this age group. ITBI prevention has focused on educating parents of young infants, an approach which is unlikely to decrease the incidence in older children. There is an urgent need to re-assess the approaches and timing of primary prevention of ITBI and to further explore the possible etiologies and generalizability of these findings on a national or international scale.

Learning Objectives:
To be able to discuss what may be an change in the epidemiology of inflicted traumatic brain injury, the leading cause of death from child abuse.

Keywords: Child Abuse, Violence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a physician and an expert in the subject of inflicted brain injuries. I helped conceive of the idea for and collect data for the abstract. I am involved in research in the field of pediatric brain injury.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Health Disparities and Violence Epidemiology Poster Session
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