Abusive Head Trauma (SBS) - Costs, Benefits and Prevention: New Zealand Does the Maths!

The abstract below is from the November 2012 edition of the Journal of Child Abuse and Neglect.  

The full article is behind a paywall, but the abstract indicates this study from the folks at Starship Children’s in NZ will be a solid step forward in making the economic case for prevention.  Click on this link for the abstract. 

More good work from the Starship!

PS. This seems to provide a good template for replicating the analysis on our side of the Equator, no?

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Primary prevention of pediatric abusive head trauma: A cost audit and cost-utility analysis.J Friedman, P Reed, P Sharplin, and P KellyChild Abuse Negl, November 8, 2012
Te Puaruruhau (Child Protection Team), Starship Children's Hospital, Private Bag 92024,Auckland 1142, New Zealand. OBJECTIVES: To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program.
 METHODS: A 5 year cohort of infants with abusive head trauma admitted to hospital inAuckland, New Zealand was reviewed. We determined the direct costs of hospital care (from hospital and Ministry of Health financial records), community rehabilitation (from the Accident Compensation Corporation), special education (from the Ministry of Education), investigation and child protection (from the Police and Child Protective Services), criminal trials (from the Police, prosecution and defence), punishment of offenders (from the Department of Corrections) and life-time care for moderate or severe disability (from the Accident Compensation Corporation). Analysis of the possible cost-utility of a national primary prevention program was undertaken, using the costs established in our cohort, recent New Zealand national data on the incidence of pediatric abusive head trauma, international data on quality of life after head trauma, and published international literature on prevention programs.
 RESULTS: There were 52 cases of abusive head trauma in the sample.
 Hospital costs totaled: $NZ 2,433,340,child protection: $NZ 1,560,123,police investigation: $NZ 1,842,237,criminal trials: $NZ 3,214,020,punishment of offenders: $NZ 4,411,852 andcommunity rehabilitation: $NZ 2,895,848. Projected education costs for disabled survivors: $NZ 2,452,148, and the cost of projected lifetime care:$NZ 33,624,297.  Total costs were $NZ 52,433,864, averaging $NZ 1,008,344 per child.[NB. current exchange rate 1.00 NZ = .81 US] Cost-utility analysis resulted in a strongly positive economic argument for primary prevention, with expected case scenarios showing lowered net costs with improved health outcomes. CONCLUSIONS: Pediatric abusive head trauma is very expensive, and on a conservative estimate the costs of acute hospitalization represent no more than 4% of lifetime direct costs.If shaken baby prevention programs are effective, there is likely to be a strong economic argument for their implementation. This study also provides robust data for future cost-benefit analysis in the field of abusive head trauma prevention.

SBS Survivors: Evan Coleman, West Allis Wisconsin

WISN.com in Milwaukee has a compelling video news report on the consequences of SBS.

It's the story of Evan Coleman, who's eight years old, and the story of how his parents are working to increase awareness - even though his father is responsible for those injuries...Link

Evan's father spent seven years in prison.

His son's sentence will last much longer."He now has epilepsy. He's been hospitalized four or five times for seizures. His behavior, his social skills -- he's 8 years old and his social skills are about a 4-year-old level," Coleman said.

Coleman said a portion of Evan's brain -- the part that regulates reasoning and emotion -- is permanently damaged, so Evan goes into rages and tantrums.

The news video includes an interview with his father, who admitted that he lost was responsible for those injuries.

Evan's father, who 12 News is not identifying, was caring for him one day in 2001 when he said Evan's constant crying pushed him over the edge.

"I lost it, and I picked him up, and I shook him. I think two or three times, and I kind of tossed him into his crib, and that's when I think he hit his head on the railing of the crib," Evan's father said. "As soon as I did it, I couldn't believe what had happened, what I had done.

"He drove his son to Children's Hospital. Evan's mother -- who had been at work -- rushed to be with them.

"I remember walking into the room, and Evan was laying there in a little bed, and his eyes were black and blue, and he had cuts all over his face. He had tubes in his head. He looked like the life was pretty much sucked out of him," Jenny Coleman said. "I said, 'I will find who did this to you and they will pay.'"

She didn't have to look far.

"I was so ashamed of myself. I couldn't bring myself to say it," Evan's father said.

Within hours, Evan's father confessed.

Survivors: Matthew Washburn, Colorado

KKTV.com in southern Colorado reports on the story of Matthew Washburn. The article includes a video report.   Link to story and video.

Every parent has had to comfort a crying baby.   But inconsolable crying can lead to danger. According to CASA, Court Appointed Special Advocates, this is the #1 cause of shaken baby syndrome.   What you do in that moment literally can mean life or death for the child.

But even if the baby is shaken… and lives... what will his life be like?

"Matthew is deaf and blind and in a wheelchair and in diapers and nonverbal” said Jackie Washburn. “What kind of life is that?"

She’s talking about her adopted son Matthew. He was shaken when he was just 31 days old. Jackie adopted Matthew when he was two.   Back then, she was hopeful.   But today...

“Matthew is 13 years old and functions like a 2-month-old,” said Jackie.

Dr. Paul Grabb is a pediatric neurosurgeon in Colorado Springs.   He says it doesn't take much shaking to cause injuries like Matthew's.   “It's only a moment necessary to cause irreversible and at times fatal brain injuries,” said Dr. Grabb.

What's even more disturbing is that it's happening more and more in our community.

“We have seen … a dramatic increase in shaken baby especially from January to March of this year,” said Trudy Strewler with CASA.   In that time, at Memorial Hospital alone, there were 12 suspicious cases. That's almost half of the number of cases seen there all of last year. 

These may just be numbers.   But they could represent kids just like Matthew.   He'll never ride a bike, or smile for his school picture.   And because of his feeding tube, he'll never even have birthday cake.   It's a difficult existence for his mother to watch.

"Sometimes I just think if he got pneumonia and would just pass and go to heaven and he would have wings and he'd run and he'd jump and splash and run with kids and feel the wind in his hair, said Jackie.   “Then think I must be a terrible person to think that.   But your heart breaks to see the life that he has.   I wouldn't want to live like that."

Despite her agony over the hardships Matthew faces, Jackie knows his life is not in vain.   "His purpose was to make life better for people.   And if it’s to suffer the way he does to give a lesson to someone, Matthew's life has purpose."

From KETV in Omaha, Nebraska, a tale of redemption, I suppose. It is welcome to see a father accept responsibility for caring for the child he injured..

KETV has a video showing what Summer's life is like now...

Father Says Moment Of Anger Changed Course Of His Life
Avoiding Shaken Baby Syndrome: A Father's Story

POSTED: 8:42 pm CDT July 14, 2008

OMAHA, Neb. -- It seems once a month, you flip on the news and see the story of a child who's become a victim of Shaken Baby Syndrome.

Sometimes there's a mugshot of the accused, or a brief video of the home or day care where the alleged abuse took place. There's usually a quick condition report on the child, if the abuse doesn't kill them.

What happens to the babies who survive these devastating traumatic brain injuries?

"A third die, and that middle third, their injuries are just horrific," said Dr. Jeff DeMare, a child abuse expert at Omaha's Children's Hospital.

Summer Fuson is one of those children who nearly died after a violent encounter with her father. The 9-year-old was adopted by her paternal grandmother when she was an infant, after suffering traumatic brain injuries that left her mostly blind and unable to walk, talk or eat.

"I felt horrible," said Robbie Fuson, who served eight months in prison for injuring his daughter.

Robbie recently sat in his mother's duplex, rocking his young daughter in a large upholstered rocking chair. Every few minutes, he'd readjust her head, or rearrange her legs to keep the girl comfortable. She had no control over her arms or legs. Her eyes seemed to drift towards the light and she constantly tried to find her mouth with her thumb.

Robbie offered no excuses for causing the devastating injuries to his daughter, only an explanation of the desperate life he was living and the lasting impact on his life.

He said he was a teenaged father and his life was in a downward spiral as he worked three jobs and started using and selling drugs. Summer's mother, Amy Hajek, was found murdered in a ditch in Fremont about a year after Summer was injured. The homicide case remains unsolved eight years later.

Robbie said neither of them had any parenting experience. "It's a rough road to go down and I hope nobody else has to do it," he said.

Robbie now works third shift as a sanitation worker in a meat-packing plant. He has a 6-year-old daughter and he's married.

Has he forgiven himself for Summer's injuries? "As much as you can," he said. But he said society is not as forgiving.

"You just live day to day because most people find out what you've done and they look at you in a different light. They say you're such a horrible person," said Robbie.

Robbie agreed to talk about his daughter to try to prevent other parents and caregivers from making the same mistake. "If you're getting frustrated with your kids, take a break. Go outside. Cool off. Think before you do anything. Definitely think," he said.

He credits anger management classes, parenting classes and living a drug-free life for his turn around. He said getting older has also helped him appreciate his past mistakes and learn from them. He said if caregivers have anger issues, seek counseling.

"I'm not a bad guy. I was just confused when I was younger," said Robbie.

Sandy Fuson said there was a time she would not allow her son to see his daughter. "He's come full circle where he's welcome to be a part of her life. And she welcomes him into her life," Sandy said.

The grandmother works full time and takes Summer to Children's Respite Care center where nurses oversee her medical care each weekday. The mother and son live just a block away from each other in Fremont, allowing them to stay connected.

"It's a great thing to forgive and move on and try to be the whole family you want to be," said Sandy.