Disability-adjusted life-year burden of abusive head trauma at ages 0-4

Abstract

Objective: We estimated the disability-adjusted life-year (DALY) burden of abusive head trauma (AHT) at ages 0 to 4 years in the United States.

Methods: DALYs are computed by summing years of productive life that survivors lost to disability plus life-years lost to premature death. Surveying a convenience sample of 170 caregivers and pediatricians yielded health-related disability over time according to severity of AHT (measured with the Health Utilities Index, Mark 2). Incidence estimates for 2009 came from Vital Statistics for Mortality, Healthcare Cost and Utilization Program Kids' Inpatient Database for hospitalized survivors, and published ratios of 0.894 case treated and released and 0.340 case not diagnosed/treated while in the acute phase per survivor admitted. Survival probability over time after discharge came from published sources.

Results: An estimated 4824 AHT cases in 2009 included 334 fatalities within 30 days. DALYs per surviving child averaged 0.555 annually for severe AHT (95% confidence interval: 0.512-0.598) and 0.155 (95% confidence interval: 0.120-0.190) for other cases. Including life-years lost to premature mortality, estimated lifetime burden averaged 4.7 DALYs for mild AHT, 5.4 for moderate AHT, 24.1 for severe AHT, and 29.8 for deaths. On average, DALY loss per 30-day survivor included 7.6 years of lost life expectancy and 5.7 years lived with disability. Estimated burden of AHT incidents in 2009 was 69 925 DALYs or 0.017 DALYs per US live birth.

Conclusions: AHT is extremely serious, often resulting in severe physical damage or death. The annual DALY burden several years after mild AHT exceeds the DALY burden of a severe burn.

Keywords: DALY; Health Utilities Index; child abuse; maltreatment; shaken baby syndrome; traumatic brain injury.