Association of Perpetrator Relationship to Abusive Head Trauma Clinical Outcomes

• NCJ Number: 246527
• Journal: Child Abuse and Neglect Volume: 37 Issue: 10 Dated: October 2013 Pages: 771-777
• Author(s): Philip V. Scribano; Kathi L. Makoroff; Kenneth W. Feldman; Rachel P. Berger
• Date Published: October 2013
• Length: 7 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

The diagnosis of abusive head trauma AHT remains a significant public health problem with limited prevention success.

Abstract

The diagnosis of abusive head trauma AHT remains a significant public health problem with limited prevention success. Providing protection from further harm is often challenged by the difficulty in identifying the alleged perpetrator AP responsible for this pediatric trauma. The objective of this study was to evaluate demographic and clinical characteristics of children with AHT and the relationship between APs and their victims in a large, multi-site sample. Understanding the AHT risks from various caregivers may help to inform current prevention strategies. A retrospective review of all cases of AHT diagnosed by child protection teams CPT from 1/1/04 to 6/30/09 at four children's hospitals was conducted. Clinical characteristics of children with AHT injured by non-parental perpetrators NPP were compared to parental perpetrators PP. There were 459 children with AHT; 313 68% had an identified AP. The majority of the 313 children were <1 year of age 76%, Caucasian 63%, male 58%, receiving public assistance 80%, and presented without a history of trauma 62%; mortality was 19%. Overall, APs were: father 53%, parent partner 22%, mother 8%, babysitter 8%, other adult caregiver 5%; NPP accounted for 39% of APs. NPPs were more likely to cause AHT in children >_1 year 77% vs. 23%, p < 0.001 compared to PP. Independent associations to NPP included: older child, absence of a history of trauma, retinal hemorrhages, and male perpetrator gender. While fathers were the most common AP in AHT victims, there is a significant association for increased risk of AHT by NPPs in the older child, who presents with retinal hemorrhages, in the hands of a male AP. Further enhancement of current prevention strategies to address AHT risks of non-parental adults who provide care to children, especially in the post-infancy age seems warranted.