Incidence and Risk Factors for Abusive Head Trauma: A Population-Based Study

Previous studies of abusive head trauma (AHT) suggest that incidence may vary by geographic location, and there is limited information regarding population-based risk factors for this form of child maltreatment. This study provides new knowledge regarding these two aspects using the population of the US State of Washington born between 1999 and 2013. We used a linked administrative dataset comprising birth, hospital discharge, child protective services (CPS) and death records to identify the scale and risk factors for AHT for the state population using quantitative survival methods. We identified AHT using diagnostic codes in hospital discharge records defined by the US Centers for Disease Control and Prevention. A total of 354 AHT hospitalisations were identified, and the incidence for the state was 22.8 per 100 000 children under the age of one. Over 10 per cent of these children died. Risk factors included a teenaged mother at the time of birth, births paid for using public insurance, a child's low birth weight and maternal Native American race. The strongest risk factor was a prior CPS allegation, a similar finding to a California study of injury mortality. The practice and policy implications of these findings are discussed. Key Practitioner Messages A prior CPS report is a risk factor for AHT, regardless of the findings of the CPS report. Two peaks of AHT were found, one at two months and another at eight months. Prevention programming can target sociodemographic information available on birth records including teenaged mothers, low birth weight and births paid for with public insurance.