Twitter  Linkedin

Back to 2016 Annual Meeting Posters

An Evidence Based Summary Of The Association Of Non-Accidental Trauma With Specific Historical Factors, Exam Findings And Diagnostic Test Results During The Initial Evaluation Of Injured Children
Mauricio A Escobar, Jr, MD1, Marc Auerbach MD2, Katherine Flynn-O'Brien MD3, Gunjan Tiyyagura MD2, Matthew A Borgman MD4, Susan J Duffy MD5, Kelly Falcone RN, MS, CNL6, Rita Burke PhD, MPH7,8, John M Cox MD9, Sabine Maguire MBBCh, BAO, MRCPI, FRCPCH10. 1Pediatric Surgery and Pediatric Trauma, Mary Bridge Children's, Tacoma, WA, USA, 2Department of Pediatrics and Emergency Medicine, Yale University, New Haven, CT, USA, 3Department of Surgery, University of Washington, Seattle WA, USA, 4Department of Pediatrics, San Antonio Military Medical Center, Ft. Sam Houston, TX and Uniformed Services University, Bethesda, MD, USA, 5Department of Pediatric Emergency Medicine, Brown University, Providence, RI, USA, 6Department of Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 7Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA, 8Keck School of Medicine, University of Southern California, Los Angeles, CA, USA, 9Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, 10Institute of Primary Care and Health, Cardiff University School of Medicine, Cardiff, Wales, UK.

Background: Early identification of non-accidental trauma (NAT) is a critical component of pediatric trauma care.

Methods: Literature searches were conducted related to the association of NAT with seven key areas: history, exam findings (burns, oral trauma, bruising) and imaging (fractures, abdominal and brain injuries). When available, systematic reviews provided odds ratios (OR) with 95% confidence intervals (CI) for the associations with NAT.

Results: Systematic reviews have been published in 6/7 key areas (no published review for history). The operational definition of NAT is widely variable across studies. Age was typically ≤ 4 YO. Factors in each key area associated with abuse include:

History: 1) Delay in care, inconsistent history, no history of trauma, or history inconsistent with injury severity/developmental stage.

Exam: 2) Burns: scalds with clear demarcation/bilateral limb/ buttocks & lower limb; patterned contact burns. 3) Oral injury: lip injury, torn labial frenum. 4) Bruising: any in pre-mobile child, clustering (OR 4.0, CI 2.5-6.4), and petechiae (OR 9.3, CI 2.9-30.2). Imaging: 5) Fractures: rib(s), long bone(s) in children < 1 year, multiple in absence major trauma. 6) Abdominal: duodenal perforation. 7) Neurologic: subdural hematoma (OR 8.2, 6.1-11); hypoxic ischemic injury (OR 4.2, CI 0.6-2.7); retinal hemorrhages (OR 14.7, CI 6.4 to 33.6).

Conclusions: There is substantial research on factors associated with NAT. Future work is needed to create evidence-based guidelines to aid trauma providers in deciding when a comprehensive NAT evaluation should be performed. Standardization in defining NAT for research is needed.

Back to 2016 Annual Meeting Posters