Long-term impact of abusive head trauma in young children |
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| Institution: | 1. Department of Public Health Sciences, Division of Biostatistics, University of California Davis, USA;2. Department of Neurosurgery, University of Louisville, Louisville, KY, USA;3. Department of Surgery, University of California, Davis Medical Center, Sacramento, USA;4. Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, USA;5. Department of Pediatrics, University of California, Davis Medical Center, Sacramento, USA;6. Seattle Science Foundation, Seattle, WA, USA;1. University of South Carolina, School of Medicine, Department of Family & Preventive Medicine, Columbia SC, USA;2. University of South Carolina, Arnold School of Public Health, Department of Epidemiology & Biostatistics, Columbia SC, USA;1. University of Southern California, Dworak-Peck School of Social Work, University Park Campus, MRF, MC 0411, Los Angeles CA 90089, United States;2. University of Southern California, Department of Preventive Medicine, Keck School of Medicine, 2001 N. Soto St., Los Angeles, CA 90034, United States;1. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada;2. Department of Health and Kinesiology and the Public Health Graduate Program, Purdue University, Lafayette, IN, USA |
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| Abstract: | ObjectiveAbusive head trauma is the leading cause of physical abuse deaths in children under the age of 5 and is associated with severe long-lasting health problems and developmental disabilities. This study evaluates the long-term impact of AHT and identifies factors associated with poor long-term outcomes (LTOs).MethodsWe used the Truven Health MarketScan Research Claims Database (2000–2015) to identify children diagnosed with AHT and follow them up until they turn 5. We identified the incidence of behavioral disorders, communication deficits, developmental delays, epilepsy, learning disorders, motor deficits, and visual impairment as our primary outcomes.ResultsThe incidence of any disability was 72% (676/940) at 5 years post-injury. The rate of developmental delays was 47%, followed by 42% learning disorders, and 36% epilepsy. Additional disabilities included motor deficits (34%), behavioral disorders (30%), visual impairment (30%), and communication deficits (11%). Children covered by Medicaid experienced significantly greater long-term disability than cases with private insurance. In a propensity-matched cohort that differ primarily by insurance, the risk of behavioral disorders (RD 36%), learning disorders (RD 30%), developmental delays (RD 30%), epilepsy (RD 18%), and visual impairment (RD 12%) was significantly higher in children with Medicaid than kids with private insurance.ConclusionAHT is associated with a significant long-term disability (72%). Children insured by Medicaid have a disproportionally higher risk of long-term disability. Efforts to identify and reduce barriers to health care access for children enrolled in Medicaid are critical for the improvement of outcomes and quality of life. |
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| Keywords: | Abusive head trauma (AHT) Long-term outcomes Risk difference (RD) Injury severity score (ICISS) Propensity matched cohort |
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