Wirtz Stephen J, Trent Roger B
Epidemiology and Prevention for Injury Control Branch, California Department of Public Health, Sacramento, California 95899-7377, USA.
Am J Prev Med. 2008 Apr;34(4 Suppl):S134-9. doi: 10.1016/j.amepre.2007.11.004.
The conference from which these articles came addressed the question of public health surveillance for shaken baby syndrome (SBS) and explores one component of a comprehensive SBS surveillance system that would be relatively easy to implement and maintain: passive surveillance based on hospital inpatient data. Provisional exclusion and inclusion criteria are proposed for a two-level case definition of diagnosed SBS (strict definition) and cases presumed to be SBS (broad definition). The strict SBS definition is based on the single SBS code in the ICD-9-CM (995.55). The broader presumptive SBS definition is based on research studies that have identified a pattern of diagnostic codes often considered part of the clinical diagnosis of SBS.
Based on 2006 analyses, California inpatient data are presented for 1998-2004. The strict SBS definition identified 366 cases over the 7 years, whereas the broader definition captured nearly 1000 cases. Annual rates show little fluctuation from the overall rate of 5.1 for strict SBS and 14.0 for broad SBS (per 100,000 children aged <2 years). Selected demographic and outcome characteristics are presented for each definition. The broad definition produces rates that are roughly comparable to those produced in careful clinical and population-based studies that also included children who died without being hospitalized.
Despite the limitations of inpatient data, a passive surveillance system like the one proposed here can provide a critical component for a comprehensive SBS surveillance system and may be adequate for some purposes, including identifying high-risk areas or groups for intervention and monitoring trends over time.
这些文章所源自的会议探讨了针对摇晃婴儿综合征（SBS）的公共卫生监测问题，并探索了一个全面的SBS监测系统中相对易于实施和维护的一个组成部分：基于医院住院患者数据的被动监测。针对已确诊SBS（严格定义）和疑似SBS（宽泛定义）的两级病例定义，提出了临时排除和纳入标准。严格的SBS定义基于国际疾病分类第九版临床修订本（ICD - 9 - CM）中的单一SBS编码（995.55）。更宽泛的疑似SBS定义基于一些研究，这些研究确定了一种诊断编码模式，该模式常被视为SBS临床诊断的一部分。
基于2006年的分析，呈现了加利福尼亚州1998 - 2004年的住院患者数据。严格的SBS定义在这7年中识别出366例病例，而更宽泛的定义涵盖了近1000例病例。年发病率显示，严格SBS的总体发病率为每10万名2岁以下儿童5.1例，宽泛SBS为14.0例，年度发病率波动不大。针对每个定义呈现了选定的人口统计学和结局特征。宽泛定义所产生的发病率大致与精心的临床研究和基于人群的研究所产生的发病率相当，这些研究也纳入了未住院死亡的儿童。
尽管住院患者数据存在局限性，但像本文所提议的这种被动监测系统可为全面的SBS监测系统提供关键组成部分，并且可能适用于某些目的，包括识别高风险区域或群体以进行干预以及监测长期趋势。
