title: Abusive head trauma among children in Alaska: a population-based assessment.
abstract: BACKGROUND
  Serious physical abuse resulting in a traumatic brain injury (TBI) has been implicated as an underreported cause of infant mortality. Nearly 80% of all abusive head trauma (AHT) occurs among children <2 years of age, with infants experiencing an incidence nearly 8 times that of 2-year olds.
  
  
  OBJECTIVE
  This study describes the validation of the CDC Pediatric Abusive Head Trauma (PAHT) definitions when applied to a multi-source database at the state level and provides a robust annual incidence estimate of AHT among children <2 years of age in Alaska.
  
  
  METHODS
  AHT cases among children residing in Alaska during 2005-2010 were identified by applying the PAHT coding schema to a multi-source database which included vital death records, the Violent Death Reporting System (AK-VDRS), the Maternal Infant Mortality Review - Child Death Review (MIMR-CDR), the Alaska Trauma Registry (ATR), the inpatient Hospital Discharge Database (HDD) and Medicaid claims. Using these data, we calculated statewide AHT annual incidence rates.
  
  
  RESULTS
  The databases with the highest case capture rates were the ATR and Medicaid systems, both at 51%, followed by HDD at 38%. Combined, the ATR, HDD and Medicaid systems captured 91% of all AHT cases. The linkage and use of the PAHT definitions yielded an estimated sensitivity of 91% and specificity of 98%. During the study period, we detected an annual average incidence of 34.4 cases per 100,000 children aged <2 years (95% CI 25.1, 46.1) and a case fatality proportion of 22% (10/45). Among the AHT cases, 82% were infants. Significant differences (p < 0.05) in AHT were noted by age and race, but not by sex.
  
  
  CONCLUSIONS
  In Alaska, applying the CDC PAHT definition to the multi-source database enabled us to capture 49% more AHT cases than any of the individual database used in this analysis alone.
authors.affiliation: MCH-Epidemiology Unit, Alaska Division of Public Health, Anchorage, AK, USA. jwp22@live.unc.edu
authors.forename: Jared
authors.initials: J
authors.lastname: Parrish
authors.forename: Cathy
authors.initials: C
authors.lastname: Baldwin-Johnson
authors.forename: Margaret
authors.initials: M
authors.lastname: Volz
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Goldsmith
mesh_terms: D000328:Adult; D000367:Age Factors; D000413:Alaska / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D002649:Child Abuse / Q000401:mortality / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008423:Maternal Age; D044469:Racial Groups / Q000706:statistics & numerical data; D055815:Young Adult
keywords: abusive head trauma; child abuse; child maltreatment; epidemiology; surveillance; traumatic brain injury