Comparing apples with apples? Abusive Head Trauma, Drowning and LSVROs

Richard C. Franklin, ,

Other Contributors:

September 03, 2012

Kerrianne Watt1, Richard C Franklin1, Belinda Wallis2, 3, Bronwyn Griffin2, 3, Peter Leggat1; Roy Kimble2,3

1School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University

2Queensland Children's Medical Research Institute

3Royal Children's Hospital, Centre for Burns and Trauma Research, School of Medicine, University of Queensland

Re Infant Abusive Head Trauma incidence in Queensland, Australia Kaltner et al doi:10.1136/injuryprev-2012-040331

Head trauma in children, particularly as a consequence of abuse, is an important issue and we support the need for interventions in this area. We would however like to clarify some potentially misleading information published in the article by Kaltner et al, regarding the incidence of abusive head trauma (AHT) in Queensland in relation to other serious childhood trauma such as drowning and low speed vehicle run-overs (LSVROs).

Kaltner et al estimated that the incidence rate for AHT (as defined by death or admission to hospital for greater than 24 hours) among children aged 0-2 yrs in Queensland during 2005-2008 was 6.7 per 100 000 per annum. Kaltner argued that the incidence rate for AHT was higher than that for drowning and LSVROs. However, the references used for incidence rates related to drowning and LSVROs are not comparable in several respects. Firstly, there is a 10 year gap between the incidence rates for LSVROs and drowning referenced by Kaltner et al, and the calculated AHT incidence rates. The Mackie1 data on drowning are derived from 1992-1997, and the data on LSVROs from the Queensland Council on Paediatric Morbidity and Mortality2 relate to 1994-1996. Secondly, the incidence rates for drowning and LSVROs referred to by Kaltner relate to fatalities, whereas the incidence rates calculated for AHT relate to hospital admissions and fatalities. Thirdly, Kaltner et al used data relating to 0-4 yr old children in their incidence rate calculations, whereas the referenced incidence rates for drowning and LSVRO relate to 0-5 yr olds (drowning) and 0-4yr olds (LSVRO), respectively. We suggest that for these three reasons, it is not appropriate to compare incidence rates calculated for AHT and drowning / LSVROs.

We present for alternative consideration incidence rates calculated from two recently completed studies on drowning and LSVROs funded by the Queensland Injury Prevention Council. In these studies, data from multiple sources (death, hospital admission, Emergency Department presentation, ambulance) were linked to calculate incidence rates for fatal and nonfatal drowning (2002-2008) and LSVRO incidents (1999-2009)3-4. From data collected for these two studies, we have calculated incidence rates for drowning and LSVROs using the same definitions employed by Kaltner et al for AHT (i.e., fatalities and admission to hospital for 24hrs or more), for 0-2 yr old children in Queensland, for the same time period (2005-2008). The comparable incidence rates (IR) are as follows: drowning IR = 65.27 per 100 000 per annum; LSVRO IR = 42.06 per 100 000 per annum. These incidence rates are much higher than those referenced by Kaltner et al (drowning – 4.6; LSVRO 2.4).

This information is yet to be publicly released, and highlights the value of linked data when exploring injury issues. The difficulties associated with obtaining these data may explain why Kaltner et al reported incidence rates that were not directly comparable. This also reinforces the importance of defining serious injury to allow comparison of like with like5.

There is currently no linked health dataset in Queensland. Linked data to obtain accurate, contemporary and crucial information regarding injury are only available on a project by project basis, when specific funding, ethical approval, and access approval (via the Director General of Queensland Health), are obtained. In addition, funding for the Queensland Trauma Registry was terminated, thus losing another vital source of information about injury in Queensland. As highlighted earlier this year in this journal, reliable information about injuries fundamentally underpins good injury prevention6

There is no doubt that AHT among young children is an important issue and one that deserves increased attention and focus on prevention. However this does not diminish the importance of other causes of serious and fatal injury among young children, such as drowning and LSVROs. We advocate for urgent attention on better data collection regarding serious injury in Queensland to facilitate prevention strategies for all injury among children.

References:

1. Mackie IJ. Patterns of Drowning in Australia, 1992-1997. Medical Journal of Australia; 1999; 171:587-90.

2. Queensland Council on Obstetric and Paediatric Morbidity and Mortality. Maternal, Perinatal and Paediatric Morbidity and Mortality 1994-1996. Brisbane: Queensland Council on Obstetric and Paediatric Morbidity and Mortality. Brisbane, 1998.

3. Kimble R, Wallis B, Nixon J, Watt K, Cass D, Gillen T & Griffin B. 10 Year Review of Low Speed Vehicle Run-Overs in 0-15 years across Queensland. Injury Prevention; 2010; 16 (Suppl 1): A1-289.

4. Wallis B, Watt K, Franklin R, Nixon JA, Kimble R. Nonfatal drowning in children and young people in Queensland (Australia) 2002-2008. Injury Prevention; 2010; 16 (Suppl 1): A138

5. Langley J, Cryer C. A consideration of severity is sufficient to focus our prevention efforts. Injury Prevention; 2012; 18(2) 73-74.

6. Langley JD, Davie GS, Simpson JC. Quality of hospital discharge data for injury prevention. Injury Prevention; 2007; 13: 42-44.

Conflict of Interest

None declared