ABSTRACT

Abusive head trauma (AHT, formerly known as Shaken Baby Syndrome) is a serious form of maltreatment of young children. It appears to be virtually absent in South Africa, which is puzzling in a country where maltreatment rates are several times higher than the global average. Children under age 3 are most vulnerable to injury or death from shaking. We examined two sources of data to establish whether AHT occurs in South Africa and what the incidence rate is: records of injuries of children under age 3 from a tertiary hospital trauma unit (the ChildSafe database 1996–2015), and autopsy records of deaths of children under age 3 from three Magistrates’ Courts in greater Cape Town, South Africa (2006–2016). Of the 52,165 injuries in this age-group in the ChildSafe database, there were only three accounts of shaking, of which only one caused injury. However, the structure of the database made it impossible to identify clusters of injuries that may have resulted from AHT, nor were doctors constrained to indicate whether shaking had occurred. There were no reports of shaking in autopsy findings, although several cases had indications that shaking may have occurred. It therefore remains unclear as to whether AHT is occurring in South Africa. In order to detect shaking in future, we recommend that: (1) the form which doctors in trauma units are required to complete explicitly enquires about this; (2) doctors performing autopsies are provided with a standard protocol that requires them to investigate the possibility of AHT; (3) a prospective study of infants and caregivers be conducted, to establish the incidence of shaking and whether it causes injury.

摘要

虐待性头部外伤（AHT，以前称为摇晃婴儿综合症）是对幼儿的一种严重虐待形式。南非似乎几乎没有这种情况，在一个虐待率比全球平均水平高几倍的国家，这令人费解。3 岁以下的儿童最容易因摇晃而受伤或死亡。我们检查了两个数据来源以确定 AHT 是否发生在南非以及发病率是多少：三级医院创伤科的 3 岁以下儿童受伤记录（ChildSafe 数据库 1996-2015），以及死亡的尸检记录。来自南非大开普敦三个地方法院的 3 岁以下儿童（2006-2016 年）。在 ChildSafe 数据库中该年龄组的 52,165 起伤害中，只有 3 起因摇晃引起的事故，其中只有 1 起造成伤害。然而，数据库的结构使得无法识别可能由 AHT 引起的损伤集群，医生也无法说明是否发生了摇晃。尸检结果没有关于震动的报告，尽管有几个案例表明可能发生了震动。因此，尚不清楚南非是否正在发生 AHT。为了将来检测到晃动，我们建议： (1) 要求创伤科医师填写的表格明确询问此问题；(2) 为进行尸检的医生提供标准协议，要求他们调查 AHT 的可能性；(3) 对婴儿和看护者进行前瞻性研究，以确定摇晃的发生率以及是否会造成伤害。数据库的结构使得无法识别可能由 AHT 引起的损伤集群，医生也无法确定是否发生了摇晃。尸检结果没有关于震动的报告，尽管有几个案例表明可能发生了震动。因此，尚不清楚南非是否正在发生 AHT。为了将来检测到晃动，我们建议： (1) 要求创伤科医师填写的表格明确询问此问题；(2) 为进行尸检的医生提供标准协议，要求他们调查 AHT 的可能性；(3) 对婴儿和看护者进行前瞻性研究，以确定摇晃的发生率以及是否会造成伤害。数据库的结构使得无法识别可能由 AHT 引起的损伤集群，医生也无法确定是否发生了摇晃。尸检结果没有关于震动的报告，尽管有几个案例表明可能发生了震动。因此，尚不清楚南非是否正在发生 AHT。为了将来检测到晃动，我们建议： (1) 要求创伤科医师填写的表格明确询问此问题；(2) 为进行尸检的医生提供标准协议，要求他们调查 AHT 的可能性；(3) 对婴儿和看护者进行前瞻性研究，以确定摇晃的发生率以及是否会造成伤害。