Miller Ted R, Steinbeigle Ryan, Wicks Amy, Lawrence Bruce A, Barr Marilyn, Barr Ronald G
Pacific Institute for Research and Evaluation, Calverton, Maryland; Centre for Population Health Research, Curtin University, Perth, Australia;
National Center on Shaken Baby Syndrome, Farmington, Utah; and.
Pediatrics. 2014 Dec;134(6):e1545-50. doi: 10.1542/peds.2014-1385. Epub 2014 Nov 17.
We estimated the disability-adjusted life-year (DALY) burden of abusive head trauma (AHT) at ages 0 to 4 years in the United States.
DALYs are computed by summing years of productive life that survivors lost to disability plus life-years lost to premature death. Surveying a convenience sample of 170 caregivers and pediatricians yielded health-related disability over time according to severity of AHT (measured with the Health Utilities Index, Mark 2). Incidence estimates for 2009 came from Vital Statistics for Mortality, Healthcare Cost and Utilization Program Kids' Inpatient Database for hospitalized survivors, and published ratios of 0.894 case treated and released and 0.340 case not diagnosed/treated while in the acute phase per survivor admitted. Survival probability over time after discharge came from published sources.
An estimated 4824 AHT cases in 2009 included 334 fatalities within 30 days. DALYs per surviving child averaged 0.555 annually for severe AHT (95% confidence interval: 0.512-0.598) and 0.155 (95% confidence interval: 0.120-0.190) for other cases. Including life-years lost to premature mortality, estimated lifetime burden averaged 4.7 DALYs for mild AHT, 5.4 for moderate AHT, 24.1 for severe AHT, and 29.8 for deaths. On average, DALY loss per 30-day survivor included 7.6 years of lost life expectancy and 5.7 years lived with disability. Estimated burden of AHT incidents in 2009 was 69 925 DALYs or 0.017 DALYs per US live birth.
AHT is extremely serious, often resulting in severe physical damage or death. The annual DALY burden several years after mild AHT exceeds the DALY burden of a severe burn.
我们估算了美国0至4岁儿童虐待性头部创伤（AHT）的伤残调整生命年（DALY）负担。
DALY通过将幸存者因残疾而损失的生产性生活年数与因过早死亡而损失的生命年数相加来计算。对170名照料者和儿科医生进行便利抽样调查，根据AHT的严重程度（用健康效用指数Mark 2衡量）得出随时间推移的与健康相关的残疾情况。2009年的发病率估计来自死亡率生命统计数据、医疗保健成本和利用项目儿童住院数据库中的住院幸存者数据，以及已发表的每例入院幸存者在急性期接受治疗并出院的比例0.894和未诊断/治疗的比例0.340。出院后随时间推移的生存概率来自已发表的资料。
2009年估计有4824例AHT病例，其中30天内有334例死亡。重度AHT幸存儿童的年平均DALY为0.555（95%置信区间：0.512 - 0.598），其他病例为0.155（95%置信区间：0.120 - 0.190）。包括因过早死亡而损失的生命年数，轻度AHT的终身负担平均为4.7 DALY，中度AHT为5.4，重度AHT为24.1，死亡病例为29.8。每例30天幸存者的平均DALY损失包括7.6年的预期寿命损失和5.7年的残疾生活年数。2009年AHT事件的估计负担为69925 DALY，即每例美国活产儿0.017 DALY。
AHT极其严重，常导致严重身体损伤或死亡。轻度AHT数年后的年度DALY负担超过严重烧伤的DALY负担。
