title: Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team.
abstract: OBJECTIVE
  To describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand.
  
  
  METHODS
  Comparative review of demographics, histories, injuries, investigations and diagnostic outcomes for referrals under 15 years old from 1991 to 2010.
  
  
  RESULTS
  Records were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%).
  
  
  CONCLUSIONS
  The striking increase in referrals for AHT probably represents increasing incidence. The decision to refer a hospitalised child with a head injury for assessment for possible AHT should not be influenced by socio-economic status or ethnicity. Children over 2 years old hospitalised for AHT are usually injured by mechanisms involving impact and should be considered at high risk of death.
authors.affiliation: Te Puaruruhau (Child Protection Team), Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand Department of Paediatrics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Patrick
authors.identifier: http://orcid.org/0000-0002-8813-8877
authors.initials: P
authors.lastname: Kelly
authors.affiliation: Department of Neurosurgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: John
authors.affiliation: Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Vincent
authors.affiliation: Children's Research Centre, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D001344:Autopsy; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D000068216:Child Protective Services; D002673:Child, Hospitalized; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D009887:Ophthalmoscopy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Child Abuse; Multidisciplinary team-care; Race and Health