Eight-year outcome of implementation of abusive head trauma prevention
Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Child Abuse & Neglect
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 retrospectiveprospective 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.
Description
item.page.type
Article
item.page.format
Keywords
prevention, abusive head trauma, shaken baby syndrome, parental education, crying, infants
Citation
Barr, R. G., Barr, M., Rajabali, F., Humphreys, C., Pike, I., Brant, R., ... & Singhal, A. (2018). Eight-year outcome of implementation of abusive head trauma prevention. Child abuse & neglect, 84, 106-114.