Pediatric Abusive Head Trauma in Virginia: A Protocol for Public Health Surveillance Using the Virginia Statewide Trauma Registry

Objectives: Abusive Head Trauma (AHT) incidence may be underestimated if surveillance methods exclude children with AHT injury patterns because a minor fall was recorded as the mechanism of injury. An AHT Surveillance Pilot Protocol (AHT SPP), which includes minor falls was developed and evaluated. Methods: A retrospective review of traumatic brain injury cases in children under age three, between 2008 and 2012 was completed, using the Virginia Statewide Trauma Registry (VSTR) and Virginia Office of the Chief Medical Examiner (OCME) datasets. Non-fatal and fatal AHT rates were calculated and descriptive characteristics identified.
Results: The Centers for Disease Control and Prevention (CDC) AHT algorithm identified 78 non-fatal AHT cases and an estimated rate of 5.14 per 100,000 children. The AHT SPP identified an additional 158 non-fatal AHT cases and the combined results estimated a non-fatal AHT rate of 15.56 per 100,000 children. An AHT fatality rate of 4.15 per 100,000 children was reported, with 63 deaths. Conclusions: The AHT SPP, which includes minor falls, may provide a useful model for calculating more inclusive and accurate rates of non-fatal and fatal AHT.

Pilot Study protocol for public health surveillance of pediatric abusive head trauma, which includes traumatic brain injury cases reportedly caused by a minor fall.