Abusive Head Trauma: Incidence and Associated Factors in Queensland

Melissa Kaltner (2010). Abusive Head Trauma: Incidence and Associated Factors in Queensland PhD Thesis, School of Medicine, The University of Queensland.

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Author Melissa Kaltner
Thesis Title Abusive Head Trauma: Incidence and Associated Factors in Queensland
School, Centre or Institute School of Medicine
Institution The University of Queensland
Publication date 2010-12
Thesis type PhD Thesis
Supervisor Professor Justin Kenardy
Dr Robyne LeBrocque
Dr Andrew Page
Total pages 162
Total colour pages 12
Total black and white pages 150
Subjects 11 Medical and Health Sciences
Abstract/Summary Abstract Aims Abusive head trauma (AHT) has been the focus of considerable research in recent years. Little research on AHT has been conducted in the Australian context despite the serious nature of injuries evident in AHT cases. The studies presented within this thesis establish the incidence of AHT in the state of Queensland, Australia, and identify factors associated with its occurrence. Incidence Studies Two studies were designed to provide the first Australian AHT incidence estimates. The first study examined the incidence of both severe and less severe AHT within the north Brisbane area. The second study undertook a state-wide examination of AHT, ascertaining severe cases and extrapolating findings from the Brisbane based study to estimate the total incidence of AHT across the state of Queensland. North Brisbane Incidence Study. The study presented in Chapter 3 examined the occurrence of AHT in north Brisbane, Queensland. Retrospective review of medical records for infants aged 0 to 24 months presenting with head injury during the five year period of 2004 to 2008 to the Royal Children’s Hospital Brisbane was undertaken. AHT cases were identified through use of an algorithm. The study established the incidence of coded AHT in addition to presumed AHT, indicating rates of 8.4 (CI = 4.1 – 15.8) severe and 13.7 (CI = 7.7 – 22.2) less severe cases per 100,000 infants. The study provided the information necessary to estimate the full span of AHT incidence within the state, as was conducted in the following study. State-wide Incidence Study. The study presented in Chapter 4 ascertained the incidence of AHT in Queensland. Data linkage between the Queensland Trauma Registry and the Commission for Children and Young People and Child Guardian’s Child Death Register was undertaken in order to identify all cases of severe AHT occurring in Queensland infants aged less than 24 months during the four year period of 2005 to 2008. An incidence of 11.9 (CI = 6.2 – 19.7) cases of severe AHT and 17.7 (CI = 10.7 – 27.2) cases of less severe AHT per 100,000 Queensland infants was established by the study, providing the first large-scale estimate of Australian AHT incidence. Associated Factors Studies Two studies examined infant and injury characteristics associated with AHT in the Australian context. The north Brisbane based study allowed for investigation into factors associated with AHT in this population, with comparison made between AHT cases of varying severity levels and coding types. The following study examined factors associated with severe AHT across the state of Queensland, comparing injury and infant characteristics in cases of AHT to those of alternate injury types. Infant Characteristics Associated with AHT in North Brisbane. The study presented in Chapter 5 investigated factors sharing a relationship with AHT within north Brisbane. Infants of Aboriginal and Torres Strait Islander status were found to be more frequently represented in cases of AHT than within the infant population in the area. No significant differences in AHT cases of varying severity or coding types were identified. Infant and Injury Characteristics Associated with AHT in Queensland. The study presented in Chapter 6 examined the infant characteristics and injury factors associated with severe AHT in Queensland. In order to examine factors associated with AHT, multivariate comparisons between AHT, other injury, accidental head injury and abusive non head injury were made. Results highlighted the specificity of young infant age to the occurrence of AHT and demonstrated two peaks in the occurrence of AHT by age, with the first at 2 months and a peak of late-onset cases evident at 9 months. The findings indicated that infant sex was not associated with AHT. ATSI infants were found to be overrepresented in injury cases on a whole. The findings highlighted the range of socio-economic backgrounds in which infants experiencing AHT resided. The relative clinical complexity of AHT injuries was clear, with infants experiencing AHT requiring longer lengths of stay and demonstrating injuries of higher severity than infants experiencing other injury types. Conclusion The studies presented within this thesis provide the first Australian incidence estimates for AHT, and detail the infant characteristics and injury profile associated with its occurrence. The findings indicate a rate of AHT in Queensland which is comparable to that documented in international examinations and to many other well-researched causes of infant morbidity and mortality. The studies highlight the relative frequency of AHT in the Australian context and provide the foundation of knowledge necessary for Australian based AHT incidence monitoring and prevention program design.
Keyword Abusive head trauma
shaken baby syndrome
Brain injury
Subdural Haematoma
Additional Notes Colour pages: 45, 61, 68, 69, 88, 101, 103, 104, 105, 131, 132, 133. Landscape pages: 50, 53, 70, 71, 102, 153, 158, 160.

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Created: Fri, 17 Jun 2011, 07:52:17 EST by Ms Melissa Kaltner on behalf of Library - Information Access Service