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Non-Accidental Trauma, Predictive Values to Prevent Recurrent Injuries in Children in South Carolina
Melissa Maxey, MD, Natalie Brenders, Olga Rosa, MD, Martin Durkin, MD, PhD and Juan Camps, MD, University of South Carolina, Palmetto Health Richland, Columbia SC

Abstract:
Background: Non-accidental trauma (NAT) is a significant cause of pediatric morbidity and mortality. At our institution, suspected cases of NAT are referred to a pediatric forensics committee for further evaluation. The purpose of our study was to evaluate all suspected cases of NAT and identify predictive factors for the cases determined to be probable NAT by this committee. Methods: A retrospective chart review of all cases referred to the pediatric forensic committee for admissions in the children's hospital from 7/12/2008-3/26/2014 was performed. Variables were analyzed using likelihood ratio test criterion for NAT versus no or uncertain. Results: Of the analyzed variables, male gender yielded a significant odds ratio of 2.33 (1.01, 3.99). In regard to body system involvement, odds ratios were as follows: genitalia 6.12 (1.57, 23.88), abdomen 5.77 (1.51, 21.97), chest 9.33 (3.13, 27.82), bones 2.01 (.79, 5.11), cutaneous 5.3 (2.31, 12.15), and head 3.37 (1.49, 7.63). A diagnosis of failure to thrive had the most significant odds ratio of 16.38 (4.7, 57.10). An emergency department visit within six months of referral had an odds ratio of 2.22 (.99, 4.98). Other candidate predictors including age, race, and type of insurance did not yield significant interpretations. Conclusions: Early recognition of NAT is important to allow appropriate intervention for vulnerable patients to reduce the risk of life-threatening injuries. Our study identified multiple strong predictors of NAT within the population of suspected patients. These predictors may lead to earlier identification of NAT within the broader population of pediatric patients.
Objective:
Identify established predictors of non-accidental trauma.
Objective Content: Discuss methods of systems improvement for earlier identification of non-accidental trauma within communities.


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