Evaluating the Epidemiology of Inflicted Traumatic Brain Injury in Infants of U.S. Military Families

BackgroundEvaluating the incidence of inflicted traumatic brain injuries (inflicted TBI) in young children, and encompassing shaken baby syndrome (SBS) and related injuries, is an epidemiologic challenge. Data available regarding military families in the U.S. may complement other national surveillance efforts.MethodsA protocol was developed to assess the epidemiology of inflicted TBI among infants of U.S. military families, integrating data from the Department of Defense Birth and Infant Health Registry, healthcare utilization databases, child abuse reporting systems, and military personnel databases. The in-progress protocol, and its inherent strengths and limitations, are described here.DiscussionThe primary strengths of data from U.S. military families are related to the full characterization of the denominator, such that analyses are person-time and population based. Unique data are available to describe the full population of military parents, including occupational, geographic, and socioeconomic factors, as well as deployment-related potential stressors. The limitations of military data are similar to many other child abuse surveillance systems in that cases are underreported and not fully characterized. Linking abuse reports and medical utilization data to population data, however, will allow unique analyses of “probable” and “possible” cases of inflicted TBI in infants of military families.ConclusionsData from the U.S. military, when appropriately linked and analyzed, provide opportunities to evaluate important risk factors for inflicted TBI in infants. Although epidemiologic challenges may make incidence rates using military data noncomparable to rates using other data sources, multivariate analyses can evaluate critical and unique risk factors, as well as the effectiveness of prevention initiatives.