{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:14:44Z","timestamp":1787501684939,"version":"build-2736575974"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,11]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Research on pediatric abusive head trauma (AHT) has largely focused on clinical presentation and management. The authors sought to review a single-institution experience from a public health perspective to gain a better understanding of the local population affected, determine overall incidence and seasonal trends, and provide details on the initial hospitalization, including extent of injuries, neurosurgical interventions, and hospital charges.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n All cases of AHT involving patients who presented to Le Bonheur Children's Hospital (LBCH) from 2009 through 2014 were identified. AHT was defined as skull fracture or intracranial hemorrhage in a child under the age of 5 years with a suspicious mechanism or evidence of other intentional injuries, such as retinal hemorrhages, old or new fractures, or soft-tissue bruising. Injuries were categorized as Grade I (skull fracture only), Grade II (intracranial hemorrhage or edema not requiring surgical intervention), or Grade III (intracranial hemorrhage requiring intervention or death due to brain injury).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Two hundred thirteen AHT cases were identified. The demographics of the study population are similar to those reported in the literature: the majority of the patients involved were 6 months of age or younger (55%), male (61%), African American (47%), and publicly insured (82%). One hundred one neurosurgical procedures were performed in 58 children, with the most common being bur hole placement for treatment of subdural collections (25%) and decompressive hemicraniectomy (22%). The annual incidence rate rose from 2009 (19.6 cases per 100,000 in the population under 5 years of age) to 2014 (47.4 cases per 100,000) and showed seasonal peaks in January, July, and October (6-year average single-month incidence, respectively, 24.7, 21.7, and 24.7 per 100,000). The total hospital charges were $13,014,584, with a median cost of $27,939. Treatment costs for children who required surgical intervention (i.e., those with Grade III) were up to 10 times those of children with less severe injuries.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In the authors' local population, victims of AHT are overwhelmingly infants, are more often male than female, and are disproportionately from lower socioeconomic ranks. The incidence is increasing and initial hospitalization charges are substantial and variable. The authors introduce a simple 3-tiered injury classification scheme that adequately stratifies length of hospital stay and cost.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.1.peds15583","type":"journal-article","created":{"date-parts":[[2016,7,12]],"date-time":"2016-07-12T04:11:03Z","timestamp":1468296663000},"page":"542-549","source":"Crossref","is-referenced-by-count":34,"title":["Abusive head trauma: an epidemiological and cost analysis"],"prefix":"10.3171","volume":"18","author":[{"given":"Scott","family":"Boop","sequence":"first","affiliation":[{"name":"College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Axente","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Le Bonheur Children's Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blakely","family":"Weatherford","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Le Bonheur Children's Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Klimo","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Le Bonheur Children's Hospital;"},{"name":"Department of Neurosurgery, University of Tennessee Health Science Center; and"},{"name":"Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds15583","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"e1164","DOI":"10.1542\/peds.2010-3260","article-title":"Parent education by maternity nurses and prevention of abusive head trauma","volume":"128","author":"Altman","year":"2011"},{"key":"b2-peds15583","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"e470","DOI":"10.1542\/peds.2004-1896","article-title":"Preventing abusive head trauma among infants and young children: a hospital-based, parent education program","volume":"115","author":"Dias","year":"2005"},{"key":"b3-peds15583","series-title":"Child Abuse Negl","first-page":"915","article-title":"Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study","volume":"35","author":"D\u00edaz-Olavarrieta","year":"2011"},{"key":"b4-peds15583","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1542\/peds.2010-1770","article-title":"Abusive head trauma in children: a comparison of male and female perpetrators","volume":"127","author":"Esernio-Jenssen","year":"2011"},{"key":"b5-peds15583","series-title":"Child Abuse Negl","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.chiabu.2011.10.006","article-title":"The economic burden of child maltreatment in the United States and implications for prevention","volume":"36","author":"Fang","year":"2012"},{"key":"b6-peds15583","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3171\/2014.12.PEDS14607","article-title":"Initial clinical presentation of children with acute and chronic versus acute subdural hemorrhage resulting from abusive head trauma","volume":"16","author":"Feldman","year":"2015"},{"key":"b7-peds15583","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"102","DOI":"10.7326\/0003-4819-96-1-102","article-title":"The distinction between cost and charges","volume":"96","author":"Finkler","year":"1982"},{"key":"b8-peds15583","series-title":"Child Abuse Negl","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1016\/j.chiabu.2012.07.008","article-title":"Primary prevention of pediatric abusive head trauma: a cost audit and cost-utility analysis","volume":"36","author":"Friedman","year":"2012"},{"key":"b9-peds15583","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1007\/s00381-012-1714-z","article-title":"Early clinical indicators of developmental outcome in abusive head trauma","volume":"28","author":"Greiner","year":"2012"},{"key":"b10-peds15583","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3171\/jns.1968.28.1.0014","article-title":"Surgical risk as related to time of intervention in the repair of intracranial aneurysms","volume":"28","author":"Hunt","year":"1968"},{"key":"b11-peds15583","series-title":"Arch Dis Child","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1136\/archdischild-2011-300630","article-title":"Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review","volume":"96","author":"Kemp","year":"2011"},{"key":"b12-peds15583","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"441","DOI":"10.3171\/2014.4.JNS14689","article-title":"Administrative database research","volume":"122","author":"Kestle","year":"2015"},{"key":"b13-peds15583","series-title":"CMAJ","first-page":"155","article-title":"Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases","volume":"168","author":"King","year":"2003"},{"key":"b14-peds15583","series-title":"J Pediatr (Rio J)","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/j.jped.2013.01.011","article-title":"Abusive head trauma in children: a literature review","volume":"89","author":"Lopes","year":"2013"},{"key":"b15-peds15583","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"456","DOI":"10.3171\/2014.1.PEDS13393","article-title":"Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age","volume":"13","author":"Melo","year":"2014"},{"key":"b16-peds15583","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1016\/j.wneu.2015.06.060","article-title":"Outcomes research in neurosurgery: do administrative databases hold the answers?","volume":"84","author":"Michael","year":"2015"},{"key":"b17-peds15583","series-title":"J Child Neurol","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.1177\/0883073814549995","article-title":"Abusive head trauma: past, present, and future","volume":"29","author":"Narang","year":"2014"},{"key":"b18-peds15583","series-title":"Child Abuse Negl","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.chiabu.2013.02.002","article-title":"Descriptive factors of abusive head trauma in young children\u2014United States, 2000\u20132009","volume":"37","author":"Niederkrotenthaler","year":"2013"},{"key":"b19-peds15583","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"515","DOI":"10.3171\/2015.3.PEDS14544","article-title":"Outcomes and factors associated with infant abusive head trauma in the US","volume":"16","author":"Nu\u00f1o","year":"2015"},{"key":"b20-peds15583","series-title":"Inj Prev","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1136\/injuryprev-2011-040234","article-title":"Characteristics of non-fatal abusive head trauma among children in the USA, 2003\u20132008: application of the CDC operational case definition to national hospital inpatient data","volume":"18","author":"Parks","year":"2012"},{"key":"b21-peds15583","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1542\/peds.2014-0117","article-title":"The medical cost of abusive head trauma in the United States","volume":"134","author":"Peterson","year":"2014"},{"key":"b22-peds15583","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.jpeds.2013.10.075","article-title":"Functional outcomes in children with abusive head trauma receiving inpatient rehabilitation compared with children with nonabusive head trauma","volume":"164","author":"Risen","year":"2014"},{"key":"b23-peds15583","series-title":"Child Abuse Negl","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/j.chiabu.2013.04.011","article-title":"Association of perpetrator relationship to abusive head trauma clinical outcomes","volume":"37","author":"Scribano","year":"2013"},{"key":"b24-peds15583","series-title":"J Trauma Nurs","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1097\/JTN.0000000000000038","article-title":"Abusive head trauma in young children: a population-based study","volume":"21","author":"Selassie","year":"2014"},{"key":"b25-peds15583","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"e1546","DOI":"10.1542\/peds.2013-2049","article-title":"National, regional, and state abusive head trauma: application of the CDC algorithm","volume":"132","author":"Shanahan","year":"2013"},{"key":"b26-peds15583","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1016\/j.jpeds.2012.03.046","article-title":"Risk factors for mortality in children with abusive head trauma","volume":"161","author":"Shein","year":"2012"},{"key":"b27-peds15583","series-title":"South Med J","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1097\/00007611-200093050-00003","article-title":"Perpetrators of abusive head trauma: a comparison of two geographic populations","volume":"93","author":"Starling","year":"2000"},{"key":"b28-peds15583","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1542\/peds.95.2.259","article-title":"Abusive head trauma:the relationship of perpetrators to their victims","volume":"95","author":"Starling","year":"1995"},{"key":"b29-peds15583","series-title":"Acta Paediatr","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1080\/08035250500464923","article-title":"Inflicted traumatic brain injury (ITBI) or shaken baby syndrome (SBS) in Estonia","volume":"95","author":"Talvik","year":"2006"},{"key":"b30-peds15583","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1542\/peds.2010-0031","article-title":"Disparities in the evaluation and diagnosis of abuse among infants with traumatic brain injury","volume":"126","author":"Wood","year":"2010"},{"key":"b31-peds15583","series-title":"Int J Environ Res Public Health","doi-asserted-by":"publisher","first-page":"4187","DOI":"10.3390\/ijerph9114187","article-title":"Characteristics and trends of hospitalized pediatric abuse head trauma in Wuhan, China: 2002\u20132011","volume":"9","author":"Xia","year":"2012"},{"key":"b32-peds15583","series-title":"Brain Inj","doi-asserted-by":"publisher","first-page":"1555","DOI":"10.3109\/02699052.2013.831126","article-title":"Paediatric patients with abusive head trauma treated in US Emergency Departments, 2006\u20132009","volume":"27","author":"Xiang","year":"2013"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/5\/article-p542.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/5\/article-p542.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/5\/article-p542.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T09:10:04Z","timestamp":1681549804000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/5\/article-p542.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11]]},"references-count":32,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2016.1.peds15583","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11]]}}}