IMPORTANCE It is important to recognize presenting features and factors associated with mortality in abusive head trauma (AHT) owing to the severity of the diagnosis and the necessity for prompt action. OBJECTIVE To describe the prevalence and economic burden of AHT and identify factors associated with mortality. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study used the Nationwide Emergency Department Sample database to identify all emergency department visits in the US for patients younger than 5 years with a primary diagnosis of abusive head trauma between January 1, 2006, and December 31, 2018. This study was conducted in 2021. MAIN OUTCOMES AND MEASURES Prevalence, demographic characteristics, clinical characteristics, mortality, and economic burden associated with AHT. Weighted national estimates were calculated using sampling weights provided in the Nationwide Emergency Department Sample database. RESULTS From 2006 to 2018, there were an estimated 12 287 cases of emergency department visits in the US for patients younger than 5 years with a primary diagnosis of AHT. The estimated number of AHT cases decreased by 672 (95% CI, 403-940; P < .001) from 2006 to 2018. The incidence decreased by 6.7% each year (incidence rate ratio, 0.93; 95% CI, 0.93-0.94; P < .001) between 2006 and 2018. During the course of a hospital visit, 646 patients (5.3%) died. The majority of patients with a diagnosis of AHT were younger than 1 year (n = 7046; 57.3%), were male (n = 7268; 59.2%) and had Medicaid insurance (n = 8585; 70.0%). After controlling for demographic characteristics, factors associated with increased mortality were age greater than 1 year (odds ratio [OR], 2.45; 95% CI, 1.50-3.99; P < .001), first or second income quartile (OR, 1.78; 95% CI, 1.08-2.91; P = .02), midwestern United States (OR, 2.04; 95% CI, 1.04-4.00; P = .04), level 1 trauma center (OR, 2.69; 95% CI, 1.07-6.75; P = .04), orbital fracture (OR, 15.38; 95% CI, 2.41-98.18; P = .004), cerebral edema (OR, 8.49; 95% CI, 5.57-12.93; P < .001), intracranial hemorrhage (OR, 4.27; 95% CI, 1.71-10.67; P = .002), hypoxic ischemic brain injury (OR, 4.16; 95% CI, 2.13-8.10; P < .001), skull fractures (OR, 3.20; 95% CI, 1.76-5.82; P < .001), subarachnoid hemorrhage (OR, 2.43; 95% CI, 1.22-4.83; P = .01), retinal hemorrhage (OR, 2.17; 95% CI, 1.40-3.38; P < .001), and subdural hemorrhage (OR, 2.05; 95% CI, 1.05-3.98; P = .04). CONCLUSIONS AND RELEVANCE This study's findings suggest that health care disparities may be present in the treatment of AHT. Recognizing factors suggested in this investigation to be associated with higher mortality, public health efforts should be targeted toward low-income areas and in the midwestern United States.

中文翻译：

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虐待性头部外伤的眼科特征和死亡率的全国分析。

重要性 由于诊断的严重性和迅速采取行动的必要性，识别与虐待性头部外伤 (AHT) 死亡率相关的表现特征和因素非常重要。目的 描述 AHT 的患病率和经济负担，并确定与死亡率相关的因素。设计、地点和参与者 这项回顾性横断面研究使用全国急诊科样本数据库来确定 2006 年 1 月 1 日至2018 年 12 月 31 日。这项研究于 2021 年进行。主要结果和测量指标与 AHT 相关的患病率、人口统计学特征、临床特征、死亡率和经济负担。加权国家估计数是使用全国急诊部样本数据库中提供的抽样权重计算得出的。结果 从 2006 年到 2018 年，美国估计有 12287 例初诊为 AHT 的 5 岁以下患者急诊就诊。从 2006 年到 2018 年，估计 AHT 病例数减少了 672 例（95% CI，403-940；P < .001）。发病率每年下降 6.7%（发病率比，0.93；95% CI，0.93-0.94 ; P < .001) 2006 年至 2018 年间。在一次医院就诊过程中，646 名患者 (5.3%) 死亡。大多数诊断为 AHT 的患者小于 1 岁（n = 7046；57.3%），男性（n = 7268；59.2%）并且有医疗补助保险（n = 8585；70.0%）。在控制了人口特征后，结论和相关性 本研究的结果表明，在 AHT 的治疗中可能存在医疗保健差异。认识到本调查中提出的与较高死亡率相关的因素，公共卫生工作应针对低收入地区和美国中西部地区。