000			03947nab a22003377a 4500
999			_c6974 _d6974
005			20250625151542.0
008			210120s2020 -nz||||| |||| 00| 0 eng d
040			_aAFVC
082			_a362.7 KEL
100			_aKelly, Patrick _91477
245			_aPaediatric abusive head trauma in New Zealand _cPatrick Kelly
246			_aA thesis submitted in fulfilment of the requirements for the degree of Doctor of Medicine, The University of Auckland,
260			_c2020
300			_aelectronic document (230 pages) ; PDF file
500			_aThesis: Doctor of Medicine, University of Auckland
520			_aThis thesis contains eight published scientific papers concerning abusive head trauma (AHT) in New Zealand. Aim The aim was to describe children with head trauma referred to the Starship Hospital Child Protection Team for evaluation for suspected AHT (Chapter 2) including the diagnostic approach (Chapters 2 and 3); to test alternative hypotheses for AHT (Chapter 4); to examine whether risk factors could be recognised in perinatal health records (Chapter 5); to examine whether risk factors could be recognised in child protective service (CPS) or police records for whānau members prior to the time of birth (Chapter 6); to determine the economic cost (Chapter 7) and to evaluate a prevention programme in the Auckland District Health Board (Chapter 8). Methods The methods were a retrospective comparative cohort study (Chapter 2); a case report (Chapter 3); review of data from a prospective Australasian study of congenital heart disease (Chapter 4); a multi-centre retrospective case-control study (Chapter 5); a retrospective case-control study of CPS and police records (Chapter 6); a multi-agency cost audit and cost-utility analysis of economic cost and disability burden (Chapter 7); and a pilot AHT prevention programme with analysis of surveys of caregivers and health professionals (Chapter 8). Findings • 345 head injured children had findings consistent with the literature (Chapter 2); • Retinal haemorrhage was a rare complication of acute disseminated encephalomyelitis (Chapter 3); • 152 cases of congenital heart disease provided no support for alternative hypotheses of AHT (Chapter 4); • In the case-control study (142 cases and 550 controls), nine perinatal factors were associated with the risk of AHT (Chapter 5). Data from CPS or police records added little predictive value (Chapter 6); • The average lifetime cost for a single case of AHT was $11.7 million (Chapter 7); • A prevention programme was regarded positively, and key messages were remembered (Chapter 8). Conclusions The incidence of AHT in New Zealand is similar to the US and may be increasing, and the risk profile for AHT in New Zealand is consistent with international literature. Māori are over-represented in AHT and missing health information may indicate increased risk. Although prior notification to CPS or police is associated with increased risk, information from perinatal health records is at least as useful in its capacity to predict risk. The health outcomes of AHT are poor, most victims return to their whānau, most cases are not prosecuted, and many are renotified for other child protection concerns. There is a strong economic argument for prevention and a need to reconceptualise AHT in New Zealand as a health problem requiring a public health response. (Author's abstract). Record #6974
650		0	_97583 _aABUSIVE HEAD TRAUMA
650		0	_aCHILD ABUSE _9103
650		0	_aCHILD PROTECTION _9118
650		0	_aDATA ANALYSIS _9181
650		4	_aECONOMIC COSTS _95369
650		0	_aEVALUATION _9236
650		0	_aHEALTH SERVICES _9290
650		0	_aPREDICTIVE RISK MODELLING _94928
650		0	_aPREVENTION PROGRAMMES _95490
650		0	_aTHESES _9606
650		0	_aTRAUMATIC BRAIN INJURY _93258
651		4	_aNEW ZEALAND _92588
856			_uhttp://hdl.handle.net/2292/53050
942			_2ddc _cTHESIS