Epidemiology of pediatric abusive head trauma in Taiwan

  • 劉 春敏

Student thesis: Doctoral Thesis


Background: To improve the comparability of different studies on pediatric abusive head trauma (AHT) the Centers for Disease Control and Prevention(CDC) in the United States developed an International Classification of Diseases (ICD) coding algorithm for non-fatal AHT based on Ninth Revision Clinical Modification (ICD-9-CM) and for fatal AHT based on Tenth Revision (ICD-10) in 2012 The Tenth Revision Clinical Revision (ICD-10-CM) was introduced in October 2015 in the United States and January 2016 in Taiwan However no AHT study used ICD-10-CM definition for non-fatal AHT was performed Objective: We sought in this study to develop an CDC ICD-10-CM version for non-fatal AHT and to delineate the epidemiological profile of HAT in Taiwan from 2010 through 2019 Methods: We firstly used general equivalence mappings developed by the US National Center for Health Statistics to determine the ICD-10-CM version of CDC non-fatal AHT definitions We then used Taiwan National Health Insurance outpatients and inpatients claims data for years 2010 through 2019 to estimate the incidence of non-fatal AHT according to the two versions of definitions Thirdly we used treatment codes in claims data to proxy measure the severity of non-fatal AHT and five year logn-term neurological deficit outcomes Results: The number of AHT based on inpatients claims data according to narrow and broad definition was 362 and 392 respectively an 8% more cases If we based both emergency visits and inpatients claims the number of AHT was 480 and 533 respectively an 11% more cases The pattern of incidence trends were similar according to two definitions; however an increase of incidence was note during 2014-2015 More than half of the AHT cases were younger than six months Before 2015 the incidence among boys was higher than girls; however inversed after 2016 The estimated mortality among AHT was 15% and increased with age More thant half of the cases had sequelae of development delay during the follow-up period Conclusions: Incidence of AHT varied according to different definitions and based on different data sources we suggested that researchers should reveal the whole picture for stakeholders Further validity studies on ICD coding algorithms of different definitions and proxy measures of severity are needed
Date of Award2021
Original languageEnglish
SupervisorTsung-Hsueh Lu (Supervisor)

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