Leading Experts Investigate Shaken Baby Syndrome

Incidence and Prevention of this Intentional, Potentially Fatal Injury

San Diego, April 9, 2008 – Shaken Baby Syndrome (SBS), also known as childhood neurotrauma or inflicted traumatic brain injury, is the leading cause of death from childhood maltreatment. Unlike many types of child abuse, the action that causes SBS is known, occurs quickly, and is, theoretically, largely preventable. An international symposium sponsored by the National Center on Shaken Baby Syndrome examined how to establish the incidence of inflicted traumatic brain injury in young children and explored issues of definitions, passive versus active surveillance, study designs, proxy measures, statistical issues and prevention. Key findings are published in a Special Supplement to the April 2008 issue of the American Journal of Preventive Medicine.

SBS is a form of intentional injury to infants and children caused by violent shaking with or without associated contact with a hard surface. The mortality rate of victims of this intentional brain injury is about 25%, while survivors do very poorly. In a recent Canadian study, investigators found that after 10 years only 7% of the survivors were reported as “normal,” 12% were in a coma or vegetative state, 60% had a moderate or greater degree of disability and 85% would require ongoing multidisciplinary care for the rest of their lives.

Guest Editors Robert M. Reece, Desmond K. Runyan, and Ronald G. Barr and an international group of authors significantly contribute to the increasing visibility of violence against children in general and child maltreatment in particular. They state that although prevention has been a highly desired but elusive goal in the field of child abuse, the apparent potential for prevention of inflicted childhood neurotrauma in particular through universal educational initiatives, both in North America and potentially around the world, has contributed considerable urgency to the importance of addressing these challenges. The symposium participants who convened to address these measurement issues were very cognizant of these challenges.

Presentations addressed two main themes: (1) the adequacy of current and/or projected systems for measuring the incidence of shaken baby syndrome; and (2) a review of available strategies for evaluating the effectiveness of primary programs for its prevention in large jurisdictions.

Reece addressed the complex issue of nomenclature variants and how they might (or might not) be integrated. Runyan described the challenges and emerging evidence concerning rates of the caregiving risk behavior of shaking. Keenan, Minns and Trent described their experiences with active and passive surveillance systems. Bennett described the countrywide Canadian Pediatric Surveillance Program, and Ryan described the design and proposed use of the Department of Defense Birth and Infant Health Registry to measure inflicted childhood neurotrauma.

To assess strategies for evaluating the effectiveness of prevention programs in large jurisdictions, Rivara presented the strengths, weaknesses, and potential pitfalls of available designs applicable at a jurisdictional level, and Shapiro discussed whether case control designs used successfully in disease prevention research could be applied to SBS. Finally, Ellingson, Leventhal, and Weiss described comparative rates derived from retrospective passive surveillance data sets to those derived from prospective active surveillance studies, and Runyan, Berger and Barr provide an integrative proposal for the “ideal system” to measure inflicted neurotrauma incidence.

Writing in the supplement, Guest Editors Ronald G. Barr, University of British Columbia, Vancouver, and Child & Family Research Institute, and Desmond K. Runyan, The University of North Caroline, Chapel Hill, state, “…it is apparent that there is a ‘bad news/good news’ storyline emerging here. While the challenges to measuring inflicted injury are real and considerable, it is equally clear that considerable progress has been made and that reliable and valid measurement appears feasible and obtainable. Substantive work continues to be done toward providing reasonable measures that will be informative both about the nature and scope of inflicted neurotrauma in infants and about the possibility that prevention programs will be able to be demonstrated to be effective (or not) on the basis of empiric measurements. It is none too soon.”

These articles appear in a Special Supplement to the American Journal of Preventive Medicine, Volume 34, Issue 4 (April 2008), Supplement 1, published by Elsevier.

The Symposium was supported by the Doris Duke Charitable Foundation of New York and the Centers for Disease Control and Prevention (CDC). The Supplement was supported by the Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC) at the CDC, Atlanta.

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Full text of the articles is available upon request; contact eAJPM@ucsd.edu to obtain copies.
To schedule an interview with the Guest Editors contact:
For Robert M. Reece: Julie Jette at 617 636 3265 or jjette@tuftsmedicalcenter.org
For Desmond K. Runyan: Stephanie Crayton at 919 966 2860 or scrayton@unch.unc.edu
Ronald G. Barr at 604 875 3568 or rbarr@cw.bc.ca

American Journal of Preventive Medicine
Supplement: Measuring the Incidence of Inflicted Childhood Neurotrauma (Shaken Baby Syndrome)

Guest Editors

Robert M. Reece (Tufts University School of Medicine and Floating Hospital for Children at Tufts Medical Center), Desmond K. Runyan (The University of North Carolina School of Medicine and School of Public Health), Ronald G. Barr (University of British Columbia and Child & Family Research Institute)

Epidemiology: The major missing element in the global response to child maltreatment
Alexander Butchart

Inflicted Neurotrauma: Measuring What?
Inflicted childhood neurotrauma: the problem set and challenges to measuring incidence
Ronald G. Barr, Desmond K. Runyan

The challenges of assessing the incidence of inflicted traumatic brain injury: a world perspective Desmond K. Runyan

What are we trying to measure? The problems of case ascertainment
Robert M. Reece

Findings from Current Measuring Systems
Practical aspects of conducting a prospective statewide incidence study: the incidence of serious inflicted traumatic brain injury in North Carolina.
Heather T. Keenan

Incidence and demography of non-accidental head injury in Southeast Scotland from a national database
Robert A. Minns, Patricia A. Jones, Jacqueline Y-Q Mok

Passive surveillance of shaken baby syndrome using hospital inpatient data
Stephen J. Wirtz, Roger B. Trent

The Canadian Paediatric Surveillance Program: a framework for the timely data collection on head injury secondary to suspected child maltreatment
Susan O. Bennett, Danielle Grenier, Andrea Medaglia

Evaluating the epidemiology of inflicted traumatic brain injury in infants of U.S. military families
Margaret A. K. Ryan, David W. Lloyd, Ava M. S. Conlin, Gia R. Gumbs, Heather T. Keenan

Evaluating the Effectiveness of Preventive Initiatives
Evaluating the effect of an injury prevention intervention in a population
Frederick P. Rivara

Using case–control studies to assess the prevention of inflicted traumatic brain injury
Eugene D. Shapiro

Using hospital discharge data to track inflicted traumatic brain injury
Katherine D. Ellingson, John M. Leventhal, Howard B. Weiss

Defining the Ideal System
Defining an ideal system to establish the incidence of inflicted traumatic brain injury: summary of the consensus conference
Desmond K. Runyan, Rachel P. Berger, Ronald G. Barr

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

The American Journal of Preventive Medicine is ranked 11th out of 98 Public, Environmental & Occupational Health titles and 16th out of 103 General and Internal Medicine titles according to the Thomson Scientific Institute for Scientific Information's 2006 Journal Citation Reports.

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