1. Abusive head trauma (AHT) in children less than age 5 was estimated to cause a loss of 69,925 disability-adjusted life-years (DALYs) in 2009.
2. More than half of all children suffering severe AHT in 2009 were expected to die before the age of 21, with the remainder suffering a large reduction in quality of life.
Evidence Rating Level: 3 (Average)
Study Rundown: It is known that victims of AHT can suffer severe consequences, including blindness, brain damage, and early death. This study attempted to quantify the burden of disease of AHT by using DALY, a sum of the loss of productive life-years to injury plus years lost to early death. Of children under 5 who suffered severe AHT in 2009, it was estimated that more than half will die before 21 years of age, with the remainder suffering a 55% reduction in health-related quality of life. Children with mild AHT will likely suffer a 15% reduction in quality of life. The use of a small convenience sample and the subsequent extrapolation makes the results difficult to generalize. However, the paper is the first to attempt to quantify the true burden of AHT disease on the population and found it to be even greater than that of other childhood injuries, including severe burns and more general child maltreatment. This suggests that physicians, advocacy groups, and law enforcement should focus significant prevention efforts on AHT.
Relevant Reading: The medical cost of abusive head trauma in the United States
In-Depth [retrospective cohort]: In 2009, there were an estimated 4824 cases of AHT in the United States, which included 334 fatalities within 30 days of trauma. A survey was distributed to the AAP Section on Child Abuse and Neglect and online child abuse support groups which resulted in 62 cases from physicians and 108 from caregivers. These results were then combined with an estimate of AHTs in the US in 2009 to calculate severity and disability following AHT. An estimated 70% of children suffering AHT spent more than 10 days in the ICU and 57% were blind or partially blind due to shaking. The survey’s severity assessment showed that 70% of injuries were severe, 23% were moderate, and 27% mild. The value of estimated mean lifetime loss per case in 2009 was 4.7 DALYs for minor AHT, 5.4 DALYs for moderate AHT, and 24.1 DALYs for severe AHT. The estimated burden of AHT incidence in 2009 was 0.017 DALYs per live birth in the United States.
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