Demographics, Mechanisms, and Injury Patterns of Non-Accidental Trauma in Children at an Adult Level-1 Trauma Center
Madhurima Baliga, BS1; Paul Reckard, MD, MBA2; Tiffany Willard, MD2; William Hardin, MD3; Abid Khan, MD2; Gregory Day, MD2; Nichole Wallace, MD3; Marissa McLean, MSN, MBA, RN, CEN, TCRN4; Rochelle Armola, MSN2; Thomas Schroeppel, MD, MS2
1University of Colorado School of Medicine, Aurora, CO; 2UCHealth Memorial Hospital Central, Colorado Springs, CO; 3Children's Hospital Colorado, Aurora, CO
Background: Thousands of children die annually because of abuse or neglect. Studies providing a comprehensive description of non-accidental trauma (NAT) in children seen at a single center are limited. The purpose of this study is to describe the demographics, mechanisms, and injury patterns of NAT presenting to a combined adult/pediatric trauma center.
Methods: The trauma registry from an urban, adult level-1, trauma center was queried from 2014 to 2017 for children (<14 years old) who arrived at the emergency department with signs of NAT. Demographics, mechanisms, and injury patterns were abstracted.
Results: 132 patients met study criteria. NAT constituted 8.8% of pediatric emergency department visits for trauma. NAT patients were young (0.79 years). The majority were male (63.6%) and injured by a blunt mechanism (69.7%). Most patients were moderately injured (ISS-9.8), but 23.5% were severely injured (ISS>15) with a mortality of 3.0%. Skin findings were the most common injury (75.0%), followed by fractures (50.0%) and subdural hematomas (20.5%). 50.0% of patients were Caucasian and 71.2% of patients were covered by Medicaid. In 47.7% of cases, the perpetrator was an immediate family member. 22.0% of the perpetrators were active or former military. 22.7% of the victims had previously been seen by the Department of Human Services or law enforcement for NAT.
Conclusions: At this urban, adult level-1, trauma center, skin findings, fractures, and head trauma were the primary NAT injury patterns. A high index of suspicion needs to be maintained to recognize NAT and attempt to avert further injury.
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