This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (66)  • Contact me when this article is cited  Related Content  • Related letter  • Related articles  • Similar articles in JAMA  Topic Collections  • Pediatrics  • Child Abuse  • Violence and Human Rights  • Violence and Human Rights, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Heather T. Keenan, MDCM, MPH; Desmond K. Runyan, MD, DrPH; Stephen W. Marshall, PhD; Mary Alice Nocera, RN, MSN; David F. Merten, MD; Sara H. Sinal, MD

JAMA. 2003;290:621-626.

Context  Physical abuse is a leading cause of serious head injury and death in children aged 2 years or younger. The incidence of inflicted traumatic brain injury (TBI) in US children is unknown.

Objective  To determine the incidence of serious or fatal inflicted TBI in a defined US population of approximately 230 000 children aged 2 years or younger.

Design, Setting, and Subjects  All North Carolina children aged 2 years or younger who were admitted to a pediatric intensive care unit or who died with a TBI in 2000 and 2001 were identified prospectively. Injuries were considered inflicted if accompanied by a confession or a medical and social service agency determination of abuse.

Main Outcome Measure  Incidence of inflicted TBI. Multivariate logistic regression models were used to compare children with inflicted injuries with those with noninflicted injuries and with the general state population aged 2 years or younger.

Results  A total of 152 cases of serious or fatal TBI were identified, with 80 (53%) incurring inflicted TBI. The incidence of inflicted traumatic brain injury in the first 2 years of life was 17.0 (95% confidence interval [CI], 13.3-20.7) per 100 000 person-years. Infants had a higher incidence than children in the second year of life (29.7 [95% CI, 22.9-36.7] vs 3.8 [95% CI, 1.3-6.4] per 100 000 person-years). Boys had a higher incidence than girls (21.0 [95% CI, 15.1-26.6] vs 13.0 [95% CI, 8.4-17.7] per 100 000 person-years). Relative to the general population, children who incurred an increased risk of inflicted injury were born to young mothers (21 years), non–European American, or products of multiple births.

Conclusions  In this population of North Carolina children, the incidence of inflicted TBI varied by characteristics of the injured children and their mothers. These data may be helpful for informing preventive interventions.

Author Affiliations: Departments of Social Medicine (Drs Keenan and Runyan), Pediatrics (Dr Runyan), Epidemiology (Dr Marshall), Orthopedics (Dr Marshall), and Radiology (Dr Merten), University of North Carolina at Chapel Hill, and University of North Carolina Injury Prevention Research Center (Drs Keenan, Runyan, and Marshall and Ms Nocera), Chapel Hill; Department of Pediatrics, Brenner Children's Hospital, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Sinal).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Incidence of Inflicted Traumatic Brain Injury in Infants
Marvin Miller
JAMA. 2003;290(19):2542-2543.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Inflicted Brain Injury in Children
Janet M. Torpy, Cassio Lynm, and Richard M. Glass
JAMA. 2003;290(5):698.
EXTRACT | FULL TEXT  

Racial Differences in the Evaluation of Pediatric Fractures for Physical Abuse
Wendy G. Lane, David M. Rubin, Ragin Monteith, and Cindy W. Christian
JAMA. 2002;288(13):1603-1609.
ABSTRACT | FULL TEXT  

Analysis of Missed Cases of Abusive Head Trauma
Carole Jenny, Kent P. Hymel, Alene Ritzen, Steven E. Reinert, and Thomas C. Hay
JAMA. 1999;281(7):621-626.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Use of digital camera imaging of eye fundus for telemedicine in children suspected of abusive head injury
Saleh et al.
Br. J. Ophthalmol. 2009;93:424-428.
ABSTRACT | FULL TEXT  

Preventing head trauma from abuse in infants
Jenny
CMAJ 2009;180:703-704.
FULL TEXT  

Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial
Barr et al.
CMAJ 2009;180:727-733.
ABSTRACT | FULL TEXT  

Effectiveness of Educational Materials Designed to Change Knowledge and Behaviors Regarding Crying and Shaken-Baby Syndrome in Mothers of Newborns: A Randomized, Controlled Trial
Barr et al.
Pediatrics 2009;123:972-980.
ABSTRACT | FULL TEXT  

Characteristics That Distinguish Abusive From Nonabusive Head Trauma Among Young Children Who Underwent Head Computed Tomography in Japan
Fujiwara et al.
Pediatrics 2008;122:e841-e847.
ABSTRACT | FULL TEXT  

Incidence of Fractures Attributable to Abuse in Young Hospitalized Children: Results From Analysis of a United States Database
Leventhal et al.
Pediatrics 2008;122:599-604.
ABSTRACT | FULL TEXT  

Race Matters in the Prosecution of Perpetrators of Inflicted Traumatic Brain Injury
Keenan et al.
Pediatrics 2008;121:1174-1180.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Head Computed Tomography in Infants With Possible Inflicted Traumatic Brain Injury
Campbell et al.
Pediatrics 2007;120:295-304.
ABSTRACT | FULL TEXT  

Neurodevelopmental Outcomes Following Traumatic Brain Injury
Bratton
AAP Grand Rounds 2007;17:62-63.
FULL TEXT  

Neurodevelopmental Consequences of Early Traumatic Brain Injury in 3-Year-Old Children
Keenan et al.
Pediatrics 2007;119:e616-e623.
ABSTRACT | FULL TEXT  

Shaking and Other Non-Accidental Head Injuries in Children
Feldman
Arch Pediatr Adolesc Med 2007;161:108-109.
FULL TEXT  

Retinal Hemorrhages of Crush Head Injury: Learning From Outliers
Levin
Arch Ophthalmol 2006;124:1773-1774.
FULL TEXT  

Longitudinal Follow-up of Families and Young Children With Traumatic Brain Injury
Keenan et al.
Pediatrics 2006;117:1291-1297.
ABSTRACT | FULL TEXT  

Family Structure and Child Abuse
Oliver et al.
CLIN PEDIATR 2006;45:111-118.
ABSTRACT  

Traumatized Twins: A Case Report and Discussion of the Maltreatment of Multiples
Dhanani et al.
CLIN PEDIATR 2006;45:173-176.
 

Child Outcomes and Family Characteristics 1 Year After Severe Inflicted or Noninflicted Traumatic Brain Injury
Keenan et al.
Pediatrics 2006;117:317-324.
ABSTRACT | FULL TEXT  

Identification of Inflicted Traumatic Brain Injury in Well-Appearing Infants Using Serum and Cerebrospinal Markers: A Possible Screening Tool
Berger et al.
Pediatrics 2006;117:325-332.
ABSTRACT | FULL TEXT  

Child Deaths Resulting From Inflicted Injuries: Household Risk Factors and Perpetrator Characteristics
Schnitzer and Ewigman
Pediatrics 2005;116:e687-e693.
ABSTRACT | FULL TEXT  

Deaths From Residential Injuries in US Children and Adolescents, 1985-1997
Nagaraja et al.
Pediatrics 2005;116:454-461.
ABSTRACT | FULL TEXT  

Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy
Barlow et al.
Pediatrics 2005;116:e174-e185.
ABSTRACT | FULL TEXT  

Prehospital and In-Hospital Mortality: A Comparison of Intentional and Unintentional Traumatic Brain Injuries in Colorado Children
Sills et al.
Arch Pediatr Adolesc Med 2005;159:665-670.
ABSTRACT | FULL TEXT  

Epidemiologic Features of the Physical and Sexual Maltreatment of Children in the Carolinas
Theodore et al.
Pediatrics 2005;115:e331-e337.
ABSTRACT | FULL TEXT  

Traumatic Brain Injury in Children
Bratton
AAP Grand Rounds 2004;12:71-71.
FULL TEXT  

A Population-Based Comparison of Clinical and Outcome Characteristics of Young Children With Serious Inflicted and Noninflicted Traumatic Brain Injury
Keenan et al.
Pediatrics 2004;114:633-639.
ABSTRACT | FULL TEXT  

Incidence of Inflicted Traumatic Brain Injury in Infants
Miller
JAMA 2003;290:2542-2543.
FULL TEXT  

Inflicted Traumatic Brain Injury in Young Children
Aiken
AAP Grand Rounds 2003;10:61-62.
FULL TEXT  

Factors Associated with Inflicted Traumatic Brain Injury in Young Children
JWatch Emergency Med. 2003;2003:7-7.
FULL TEXT