title: National, regional, and state abusive head trauma: application of the CDC algorithm.
abstract: OBJECTIVE
  To examine national, regional, and state abusive head trauma (AHT) trends using child hospital discharge data by applying a new coding algorithm developed by the Centers for Disease Control and Prevention (CDC).
  
  
  METHODS
  Data from 4 waves of the Kids' Inpatient Database and annual discharge data from North Carolina were used to determine trends in AHT incidence among children <1 year of age between 2000 and 2009. National, regional, and state incidence rates were calculated. Poisson regression analyses were used to examine national, regional, and state AHT trends.
  
  
  RESULTS
  The CDC narrow and broad algorithms identified 5437 and 6317 cases, respectively, in the 4 years of KID weighted data. This yielded average annual incidences of 33.4 and 38.8 cases per 100,000 children <1 year of age. There was no statistically significant change in national rates. There were variations by region of the country, with significantly different trends in the Midwest and West. State data for North Carolina showed wide annual variation in rates, with no significant trend.
  
  
  CONCLUSIONS
  The new coding algorithm resulted in the highest AHT rates reported to date. At the same time, we found large but statistically insignificant annual variations in AHT rates in 1 large state. This suggests that caution should be used in interpreting AHT trends and attributing changes in rates as being caused by changes in policies, programs, or the economy.
authors.affiliation: Injury Prevention Research Center, The University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 500, CB#7505, Chapel Hill, NC 27599-7505. shanahan@unc.edu.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Shanahan
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Zolotor
authors.forename: Jared W
authors.initials: JW
authors.lastname: Parrish
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Barr
authors.forename: Desmond K
authors.initials: DK
authors.lastname: Runyan
mesh_terms: D000465:Algorithms; D002487:Centers for Disease Control and Prevention, U.S.; D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data*; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D038801:International Classification of Diseases; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010351:Patient Discharge; D016012:Poisson Distribution; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology
keywords: abuse; abusive head trauma; children