A Population-Based Study of Inflicted Traumatic Brain Injury in Young Children

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 (< or =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.