Abstract
ObjectiveTo investigate national trends of SBS diagnosis codes and how trends varied among patient and hospital characteristics.MethodsWe examined possible SBS, confirmed SBS, and non-SBS abuse diagnosis codes among children age three and younger who were hospitalized for abuse between 1998 and 2014 using a secondary analysis of the National Inpatient Sample, the largest US all-payer inpatient care database (N = 66,854). A baseline category logit model was used based on a quasi-likelihood approach (QIC) with an independent working correlation structure.ResultsThe rate (per 100,000 census population of children age 3 and younger) of confirmed and possible SBS diagnosis codes was 5.4 (± 0.3) between 1998 and 2014, whereas the rate of non-SBS abuse was 19.6 (± 1.0). The rate of confirmed SBS diagnosis codes increased from 3.8 (± 0.3) in 1998 to 5.1 (± 0.9) in 2005, and decreased to 1.3 (± 0.2) in 2014. Possible SBS diagnosis codes were 0.6 (± 0.2) in 1998, increasing to 2.4 (± 0.4) in 2014. Confirmed SBS diagnosis codes have declined since 2002, while possible SBS diagnosis codes have increased. All abuse types were more frequent among infants, males, children from low-income homes, and urban teaching hospitals.ConclusionsWe investigated seventeen-year trends of SBS diagnosis codes among young children hospitalized for abuse. The discrepancy between trends in possible and confirmed SBS diagnosis codes suggests differences in norms for utilizing SBS diagnosis codes, which has implications for which hospital admissions are coded as AHT. Future research should investigate processes for using SBS diagnosis codes and whether all codes associated with abusive head injuries in young children are classified as AHT. Our findings also highlight the relativity defining and applying SBS diagnosis codes to children admitted to the hospital for shaking injuries. Medical professionals find utility in using SBS diagnosis codes, though may be more apt to apply codes related to possible SBS diagnosis codes in children presenting with abusive head injuries. Clarifying norms for SBS diagnosis codes and refining definitions for AHT diagnosis will ensure that young children presenting with, and coded for, abusive head injuries are included in overall counts of AHT based on secondary data of diagnosis codes. This baseline data, an essential component of child abuse surveillance, will enable ongoing efforts to track, prevent, and reduce child abuse.
Highlights
Every year, approximately 33 per 100,000 infants are diagnosed with abusive head trauma in US hospitals (Shanahan et al 2013), leading to mild to moderate behavioral and cognitive problems among abuse survivors, and lifelong disability or death in severe instances (Duhaime and Christian 2019)
Though the annual incidence of abusive head trauma (AHT) likely exceeds the use of AHT diagnosis codes within hospitals, inpatient data are ideal for public health surveillance; hospital datasets provide consistent and reliable sampling frames, and uniform measures of AHT (Wirtz and Trent 2008)
Whereas shaken baby syndrome (SBS) indicates one specific mechanism of injury, i.e., shaking, AHT includes a broader range of injury mechanisms, leading the American Academy of Pediatrics (AAP) and Centers for Disease Control (CDC)’s decision to adopt AHT terminology instead of SBS (Center for Disease Control and Prevention 2012; Christian and Block 2010)
Summary
Approximately 33 per 100,000 infants are diagnosed with abusive head trauma in US hospitals (Shanahan et al 2013), leading to mild to moderate behavioral and cognitive problems among abuse survivors, and lifelong disability or death in severe instances (Duhaime and Christian 2019). Pediatric abusive head trauma (AHT) includes injuries to children’s skulls or intracranial contents that occur when perpetrators violently shake young children, with or without intentional impact (Lopes et al 2013). Mild cases of AHT may go unrecognized while moderate to severe cases require hospitalization where surveillance occurs, often using 15 diagnosis codes recommended by the Centers for Disease Control (CDC) (Center for Disease Control and Prevention 2012). AHT is the official term for intentional abusive head injuries in children, yet researchers and medical professionals formerly ascribed these injuries to shaken baby syndrome (SBS). There is no consensus among researchers that shaking alone causes AHT-like injuries, about 35% of AHT hospitalizations include a diagnosis code for SBS (Parks et al 2012). The continued reliance on SBS codes suggests that medical professionals find utility in the diagnosis, yet little is known about the use of SBS diagnosis codes per year or over time
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