title: Abusive head trauma in young children: a population-based study.
abstract: OBJECTIVE
  The objectives of this study were to provide population-based incidence estimate of abusive head trauma (AHT) in children aged 0 to 5 years from inpatient and emergency department (ED) and identify risk characteristics for recognizing high-risk children to improve public health surveillance.
  
  
  METHODS
  This was a retrospective cohort study based on children's first encounter in ED or hospital admission with a diagnosis of head trauma (HT), 2000-2010. The relationship between clinical markers and AHT was examined controlling for covariables in the model using Cox hazards regression. Kaplan-Meier incidence probability was plotted, and the number of weeks elapsing from date of birth to the first encounter with HT established the survival time (T).
  
  
  RESULTS
  Twenty-six thousand six hundred eighty-one children had HT, 502 (1.8%) resulted from abuse; 42.4% was captured from ED. Incidence varied from 28.9 (95% confidence interval [CI], 27.9-37.4) in infants to 4.1 (95% CI, 2.4-5.7) in 5-year-olds per 100,000 per year. Adjusted hazard ratio was 20.3 (95% CI, 10.9-38.0) for intracranial bleeding and 11.4 (95% CI, 8.57-15.21) for retinal hemorrhage.
  
  
  CONCLUSIONS
  Incidence estimates of AHT are incomplete without including ED. Intracranial bleeding is a cardinal feature of AHT to be considered in case ascertainment to improve public health surveillance.
authors.affiliation: From the Divisions of *Epidemiology and Biostatistics and †Emergency Medicine and Pediatric Emergency Medicine, Department of Medicine; and Divisions of ‡Pediatric Emergency Medicine and Violence Intervention and Prevention and §Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Anbesaw W
authors.initials: AW
authors.lastname: Selassie
authors.forename: Keith
authors.initials: K
authors.lastname: Borg
authors.forename: Carrie
authors.initials: C
authors.lastname: Busch
authors.forename: W Scott
authors.initials: WS
authors.lastname: Russell
mesh_terms: D017677:Age Distribution; D002423:Cause of Death; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D011159:Population Surveillance; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology