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Epidemiology of Nonaccidental Trauma in Pediatric Patients
Eric H. Rosenfeld, M.D., M.P.H. ; Brittany Johnson, M.D.; David Wesson, M.D.; Sohail R. Shah, M.D., M.S.H.A.; Adam M. Vogel, M.D.; Bindi Naik-Mathuria, M.D., M.P.H.
Baylor College of Medicine/Texas Children's Hospital, Houston, TX

Background: The purpose of this study is to characterize injury patterns, outcomes and trends of nonaccidental trauma (NAT) using a large national database.

Methods: Children <15 years presenting after NAT were identified in the 2007-2014 National Trauma Databank research datasets. Clinical and outcome data were analyzed using descriptive statistics, chi-square and logistic regression.

Results: Of 678,503 children 3% (19,149) presented with NAT. The majority (95%) were under 5 and 71% were under 1 year old. 59% were male. The median injury severity score (ISS) was 10 (IQR:5-19). NAT accounted for 17% of traumas and 43% of trauma deaths in children <1 year and 8% of traumas and 31% of trauma deaths in children <5. Traumatic brain injury (TBI) was the most commonly encountered diagnosis (50%), followed by extremity fractures (35%). Intra-abdominal injuries accounted for 9% of injuries. Polytrauma was common (Figure-1). 6% required an urgent operation,43% were admitted to intensive care, and 9% died. Mortality was independently associated with TBI, thoracic injury, hollow viscus injury and older age.

Conclusion: NAT is a leading cause of mortality in young children. Multiple injuries are common, requiring comprehensive evaluation and early surgical involvement.

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