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Child Abuse Negl. 2018 Oct;84:106-114. doi: 10.1016/j.chiabu.2018.07.004. Epub 2018 Aug 1.

Eight-year outcome of implementation of abusive head trauma prevention.

Author information

1
Department of Pediatrics, University of British Columbia; Canadian Institute for Advanced Research; British Columbia Children's Hospital Research Institute, Canada. Electronic address: ronaldgbarr@gmail.com.
2
National Center on Shaken Baby Syndrome, United States.
3
British Columbia Children's Hospital Research Institute, Canada.
4
Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute, Canada.
5
British Columbia Children's Hospital Research Institute; Department of Statistics, University of British Columbia, Canada.
6
Department of Pediatrics, University of British Columbia, Canada.
7
Global Health Promotion, Tokyo Medical and Dental University, Japan.
8
Department of Neurosurgery, University of British Columbia, Canada.

Abstract

Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2-4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for <12-month-olds from 10.6 (95% CI: 8.3-13.5) to 7.1 (95% CI: 4.8-10.5) or, for <24-month-olds, from 6.7 (95% CI: 5.4-8.3) to 4.4 (95% CI: 3.1-6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42-1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for <24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program.

KEYWORDS:

Abusive head trauma; Crying; Infant abuse; Parental education; Prevention; Shaken baby syndrome; Shaking

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