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Characteristics of fatal abusive head trauma among children in the USA: 2003–2007: an application of the CDC operational case definition to national vital statistics data
  1. Sharyn E Parks,
  2. Scott R Kegler,
  3. Joseph L Annest,
  4. James A Mercy
  1. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Sharyn Parks, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F64, Atlanta, GA 30341, USA; svp2{at}


Objective In March of 2008, an expert panel was convened at the Centers for Disease Control and Prevention to develop code-based case definitions for abusive head trauma (AHT) in children under 5 years of age based on the International Classification of Diseases, 10th Revision (ICD-10) nature and cause of injury codes. This study presents the operational case definition and applies it to US death data.

Methods National Center for Health Statistics National Vital Statistics System data on multiple cause-of-death from 2003 to 2007 were examined.

Results Inspection of records with at least one ICD-10 injury/disease code and at least one ICD-10 cause code from the AHT case definition resulted in the identification of 780 fatal AHT cases, with 699 classified as definite/presumptive AHT and 81 classified as probable AHT. The fatal AHT rate was highest among children age <1 year with a peak in incidence that occurred at 1–2 months of age. Fatal AHT incidence rates were higher for men than women and were higher for non-Hispanic African–Americans compared to other racial/ethnic groups. Fatal AHT incidence was relatively constant across seasons.

Conclusions This report demonstrates that the definition can help to identify population subgroups at higher risk for AHT defined by year and month of death, age, sex and race/ethnicity. This type of definition may be useful for various epidemiological applications including research and surveillance. These activities can in turn inform further development of prevention activities, including educating parents about the dangers of shaking and strategies for managing infant crying.

  • Child abuse
  • descriptive epidemiology
  • traumatic brain injury
  • public health
  • motor vehicle occupant
  • firearm
  • poisoning
  • adolescent
  • violence
  • surveillance
  • child
  • homicide
  • concussion
  • behaviour change
  • public health
  • pedestrian
  • implementation/translation

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.