Zolotor Adam J, Runyan Desmond K, Shanahan Meghan, Durrance Christine Piette, Nocera Maryalice, Sullivan Kelly, Klevens Joanne, Murphy Robert, Barr Marilyn, Barr Ronald G
Department of Family Medicine, University of North Carolina at Chapel Hill2Injury Prevention Research Center, University of North Carolina at Chapel Hill.
Department of Pediatrics, Kempe Center, University of Colorado, Aurora.
JAMA Pediatr. 2015 Dec;169(12):1126-31. doi: 10.1001/jamapediatrics.2015.2690.
Abusive head trauma (AHT) is a serious condition, with an incidence of approximately 30 cases per 100,000 person-years in the first year of life.
To assess the effectiveness of a statewide universal AHT prevention program.
DESIGN, SETTING, AND PARTICIPANTS: In total, 88.29% of parents of newborns (n = 405 060) in North Carolina received the intervention (June 1, 2009, to September 30, 2012). A comparison of preintervention and postintervention was performed using nurse advice line telephone calls regarding infant crying (January 1, 2005, to December 31, 2010). A difference-in-difference analysis compared AHT rates in the prevention program state with those of other states before and after the implementation of the program (January 1, 2000, to December 31, 2011).
The Period of PURPLE Crying intervention, developed by the National Center on Shaken Baby Syndrome, was delivered by nurse-provided education, a DVD, and a booklet, with reinforcement by primary care practices and a media campaign.
Changes in proportions of telephone calls for crying concerns to a nurse advice line and in AHT rates per 100,000 infants after the intervention (June 1, 2009, to September 30, 2011) in the first year of life using hospital discharge data for January 1, 2000, to December 31, 2011.
In the 2 years after implementation of the intervention, parental telephone calls to the nurse advice line for crying declined by 20% for children younger than 3 months (rate ratio, 0.80; 95% CI, 0.73-0.87; P < .001) and by 12% for children 3 to 12 months old (rate ratio, 0.88; 95% CI, 0.78-0.99; P = .03). No reduction in state-level AHT rates was observed, with mean rates of 34.01 person-years before the intervention and 36.04 person-years after the intervention. A difference-in-difference analysis from January 1, 2000, to December 31, 2011, controlling for economic indicators, indicated that the intervention did not have a statistically significant effect on AHT rates (β coefficient, -1.42; 95% CI, -13.31 to 10.45).
The Period of PURPLE Crying intervention was associated with a reduction in telephone calls to a nurse advice line. The study found no reduction in AHT rates over time in North Carolina relative to other states. Consequently, while this observational study was feasible and supported the program effectiveness in part, further programmatic efforts and evaluation are needed to demonstrate an effect on AHT rates.
虐待性头部创伤（AHT）是一种严重疾病，在生命的第一年发病率约为每10万人年30例。
评估一项全州范围的通用AHT预防计划的有效性。
设计、设置和参与者：北卡罗来纳州共有88.29%的新生儿父母（n = 405060）接受了干预（2009年6月1日至2012年9月30日）。使用关于婴儿哭闹的护士咨询热线电话（2005年1月1日至2010年12月31日）对干预前后进行了比较。一项差异分析比较了预防计划实施前后该州与其他州的AHT发生率（2000年1月1日至2011年12月31日）。
由国家摇晃婴儿综合征中心制定的“紫色哭泣期”干预措施，通过护士提供的教育、DVD和小册子进行实施，并通过初级保健机构和媒体宣传活动进行强化。
使用2000年1月1日至2011年12月31日的医院出院数据，干预后（2009年6月1日至2011年9月30日）生命第一年中向护士咨询热线咨询哭闹问题的电话比例变化以及每10万名婴儿的AHT发生率变化。
在干预实施后的2年里，3个月以下儿童向护士咨询热线咨询哭闹问题的电话减少了20%（率比，0.80；95%可信区间，0.73 - 0.87；P < 0.001），3至12个月大儿童的此类电话减少了12%（率比，0.88；95%可信区间，0.78 - 0.99；P = 0.03）。未观察到州一级AHT发生率的降低，干预前平均发生率为每10万人年34.01例，干预后为每10万人年36.04例。对2000年1月1日至2011年12月31日进行的差异分析，控制经济指标后表明，该干预对AHT发生率没有统计学上的显著影响（β系数， - 1.42；95%可信区间， - 13.31至10.45）。
“紫色哭泣期”干预措施与向护士咨询热线的电话减少有关。该研究发现，相对于其他州，北卡罗来纳州的AHT发生率并未随时间降低。因此，虽然这项观察性研究可行且部分支持了该计划的有效性，但仍需要进一步的计划努力和评估来证明对AHT发生率的影响。
