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Identifying Child Abuse: A Comparison of Non-Accidental vs. Accidental Trauma Victims
Rebecca Ragar, MPH, Crystal Silva, MPH, Stephanie Zimmerman, MD, Summer Magoteaux, RN, BSN, Nicole Schuren, LMSW, IMH-E (III), Amira El-Ahmadiyyah, LCSW, David M Notrica, MD and Pamela Garcia-Filion, PhD, MPHPhoenix Children's Hospital, Phoenix AZ

Abstract: Objective: Examine patient and injury characteristics associated with non-accidental trauma (NAT) for development of a screening algorithm. Methods: Retrospective analysis of pediatric (<18 years) patients evaluated for suspected (s)NAT based on physical, emotional and/or sexual abuse findings. Patients classified by child abuse specialists as probable abuse (pNAT) were compared to patients evaluated for sNAT who experienced accidental injury. The study period was January 2007–April 2014. Descriptive statistics were used and odds ratios (95%CI) estimated. Results: 1,272 patients were evaluated for sNAT; of which 517 (41%) were classified as pNAT. Infants (<12 months) comprised 58% of pNAT patients; preterm gestation 16%, twin gestation 4%, and kinship care 5%. pNAT patients were commonly uninsured or on Medicaid (83%). No reported mechanism of injury was noted in 80%. Physical abuse was identified in 92%; 51% were abusive head trauma. Caregiver history of domestic violence (OR 9.2; 95%CI: 3.9, 22.1) or police record (OR 15.5; 95%CI: 6.1, 39.7) are associated with the highest odds of abuse; kinship care (OR 4.0; 95%CI: 1.2, 13.5), preterm gestation (OR 2.3; 95%CI: 1.3, 3.9), and twin gestation (OR 1.8; 95%CI: 0.7, 4.9). In pNAT cases, biological parents constituted 65% of suspected perpetrators; significant others 21%. Death occurred in 31 pNAT patients; 94% (n=29) were <5 years of age, and 33% (n=10) had prior CPS involvement. Conclusions: Screening algorithm factors for abuse should include: age, preterm gestation, twin gestation, lack of a reported mechanism, kinship care, caregiver history of domestic violence, CPS involvement, police record, and payor source.

Objective: At the end of this activity, the learner will be able to identify patient and injury characteristics that should be included in a non-accidental trauma screening algorithm.

Objective Content: demographic, clinical, and social characteristics of non-accidental trauma


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