Traumatic brain injuries, fractures occurred among young abuse victims

One in 2,000 children aged younger than 12 months experienced abuse-related traumatic brain injuries and/or fractures, although accidental falls were responsible for most of these injuries in children aged younger than 3 years, recent study data indicate.

To ascertain the incidence of abuse when compared with accidents among young children with traumatic brain injury, fractures or both, researchers from the Yale University School of Medicine examined information from the 2006 Kids’ Inpatient Database.

For their analysis, they focused on children aged younger than 36 months and divided them into three groups according to injury. The researchers also split children with fractures into three subgroups: those with skull fractures; those with skull and nonskull fractures; and those with nonskull fractures. Cause of injury, such as abuse, accidental fall or motor vehicle accident, was determined by the attending physician using ICD-9-CM codes.

Of the 18,822 children included in the study, 18.7% had traumatic brain injuries, 19.3% had fractures in addition to traumatic brain injuries and 62.1% had fractures only, according to the researchers. Overall incidence of all injuries was 152.5 cases per 100,000 children aged younger than 3 years (95% CI, 137.4-167.6). At 201.8 per 100,000, incidence appeared highest among children aged younger than 1 year (95% CI, 181.2-222.4) when compared with children aged 12 to 23 months and those aged 24 to 35 months.

Incidence of abuse-related traumatic brain injuries and/or fractures was 21.9 per 100,000 for children aged younger than 3 years and 50 per 100,000 for children aged younger than 1 (95% CI, 42.6-57.4), data showed. Rates remained lower among older children.

Abused children comprised 14.4% of the study sample and 23% of children with traumatic brain injury, the researchers reported. Of children aged younger than 1 year with at least one type of injury, 24.8% had been abused. This percentage, however, decreased as age increased. Results also indicated that 29.9% of all abused children had traumatic brain injury only, while 41.8% had fractures only and 28.3% had both.

Most traumatic brain injuries among children aged younger than 2 months were related to accidental falls as opposed to abuse or other accidents. Between ages 2 and 7 months, however, abuse accounted for most traumatic brain injuries.

Accidental falls were also responsible for almost all cases of skull fractures only among children aged younger than 1 year, but nonskull fractures among children aged younger than 6 months were most commonly caused by abuse, the researchers said.

“Because these types of abusive injuries are not rare, they should be the target of prevention programs that have become widespread in the United States,” the researchers wrote.

Study findings also showed a relationship between type of insurance and the likelihood of abuse. For all three types of injuries, most abused children were enrolled in Medicaid or uninsured.

“Because 74.5% to 80.7% of the abused children were enrolled in Medicaid or had no insurance, funding from this government program might aim to prevent the injuries themselves and thus decrease the costs of hospitalizations,” the researchers wrote.

Leventhal JM. Pediatrics. 2010;doi: 10.1542/peds.2009-1076.