Estimating the burden of SBS: are HDR useful? An evaluation of hospital discharge records as a tool for SBS surveillance.

Background The diagnosis of Shaken Baby Syndrome is difficult and may be influenced by patient, practitioner, and system factors. Previous studies have demonstrated potential lethal consequences if cases of abuse are missed and suggested the need of improving the accuracy of diagnosis of suspected abuse. Yet, the burden of missed cases is diffucult to be estimated. Aim To evaluate the possibility to utilize available current statistics to estimate the missed diagnoses of SBS cases in a Region of North-East Italy. Methods A cross-sectional study of the hospital discharge databases has been carried out. For all the hospitals of Veneto Region (4.5 milion inhabitants; 700,000 under the age of 15), all State-mandated Hospital Discharge Records (HDR) have been evaluated from 2001 through 2004. Suspicious case have been identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes identifing child abuse (955.5x, including SBS 955.55), brain and head injury (all types of injury, 850-854), ophtalmological injury (expecially retinal hemorrage), long bones fractures; rib and vertebral fractures.Children aged 1 year or younger were considered for the analysis. A descriptive analysis was carried out. Results In the 4-year period considered, 3,831,832 admissions have been counted. Among these, 92,6940 admission presented one of the ICD-9-CM codes considered for the analysis, 1,360 were under the age of 1 year for a total amount of 1314 patients (M:F=1:0.85). Most of admissions’ lenght of stay was 1 day, while a 9.4% of admissions lasted more than 5 days (range 1-123 days). A seasonal variation has been registered with a peak between the months of april and august. SBS specific diagnosis of discharge has been registered in 1 single case in 4 years, while aspecific diagnosis of child physical abuse in 25 cases. 33 case had highly suspicious lesion but no explicit diagnosis of child abuse. For the remaining cases the lack of information on the circumstances surrounding the event make the discrimination between intentional and unintentional impossible. Conclusions Hospital discharge data appear to highly underestimate the incidence of SBS. A sensibilization on the importance of the diagnosis of SBS for the future of the child and the need for professionals training on this specific issue seem to be urgently needed. Available current statistics can only provide an idea of the tip of the iceberg.