@article{ref1,
title="Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team",
journal="Archives of disease in childhood",
year="2015",
author="Kelly, Patrick and John, Simon and Vincent, Andrea L. and Reed, Peter",
volume="100",
number="12",
pages="1123-1130",
abstract="AIM: To describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand. <br><br>METHODS: Comparative review of demographics, histories, injuries, investigations and diagnostic outcomes for referrals under 15 years old from 1991 to 2010. <br><br>RESULTS: Records were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%). <br><br>CONCLUSIONS: The striking increase in referrals for AHT probably represents increasing incidence. The decision to refer a hospitalised child with a head injury for assessment for possible AHT should not be influenced by socio-economic status or ethnicity. Children over 2 years old hospitalised for AHT are usually injured by mechanisms involving impact and should be considered at high risk of death.<p /> <p>Language: en</p>",
language="en",
issn="0003-9888",
doi="10.1136/archdischild-2014-306960",
url="http://dx.doi.org/10.1136/archdischild-2014-306960"
}