title: Simulation of the Impact of Programs for Prevention and Screening of Pediatric Abusive Head Trauma.
abstract: Primary prevention programs of pediatric abusive head trauma (PAHT) exist and early screening is proposed, but negative effects of mislabeling parents as abusers, an important issue, are not well documented. The aim of our study was to simulate the possible impact of programs for the primary prevention and screening of PAHT. We developed Markov models that simulate the life histories of PAHT with no intervention, with primary prevention program only, with screening program, and with both programs in a hypothetical cohort of 800,000 newborns in a high-income country. Screening program would be addressed to all families until children are 2 years old, during repeated consultations. Potential side effects for parents being mislabeled as abusers were supposed to increase the probability of PAHT and decrease participation in screening. Time horizon was 2 years with cycles of 15 days. Outcomes were number of deaths and abused children avoided. Uncertainty was specified with probability distributions. After 2 years, the median number of deaths avoided through primary prevention would vary from 6 (95% confidence interval [CI] 2-11) to 28 (95% CI 6-51) per 100,000 newborns. Screening could prevent up to 6 (95% CI 0-29) or cause up to 66 (95% CI 0-361) deaths per 100,000 children born alive. The impact of both programs was uncertain. Our model confirmed the potential benefits of primary prevention and documented the uncertainty associated with screening of PAHT.
authors.affiliation: 1 CHU de Bordeaux, Pole de pediatrie, Service d'information medicale , Bordeaux, France .|2 Univ. Bordeaux , ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France .
authors.forename: Marion
authors.initials: M
authors.lastname: Bailhache
authors.affiliation: 2 Univ. Bordeaux , ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France .|3 Pole de sante publique, Service d'information medicale , Bordeaux, France .|4 Unité de Soutien Méthodologique à la Recherche Clinique et Épidémiologique , Bordeaux, France .
authors.forename: Antoine
authors.initials: A
authors.lastname: Bénard
authors.affiliation: 2 Univ. Bordeaux , ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France .|3 Pole de sante publique, Service d'information medicale , Bordeaux, France .
authors.forename: Louis-Rachid
authors.initials: LR
authors.lastname: Salmi
mesh_terms: D002649:Child Abuse / Q000401:mortality / Q000517:prevention & control* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D015233:Models, Statistical; D015397:Program Evaluation / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: child abuse; craniocerebral trauma; mass screening; pediatric abusive head trauma; primary prevention