Evaluating Outcomes of Nonaccidental Trauma in Military Children

Abstract

Background: Non-accidental trauma (NAT), or child abuse, is a leading cause of childhood injury and death in the United States. Studies demonstrate that military-affiliated individuals are at greater risk of mental health complications and family violence, including child maltreatment. There is limited information about the outcomes of military children who experience NAT. This study compares the outcomes between military-dependent and civilian children diagnosed with NAT. Study Design: A single institution, retrospective review was performed of children admitted with confirmed NAT at a Level I trauma center. Data was collected from the institutional trauma registry and the Child Abuse Team’s database. Military affiliation was identified using insurance status and parental/caregiver self-reported active-duty status. Demographic and clinical data including hospital length of stay (LOS), morbidities, specialty consults, and mortality were compared. Results: Among 535 patients, 11.8% (n=63) were military-affiliated. The median age of military-associated patients, 3 months (IQR 1-7), was significantly younger than civilian patients, 7 months (IQR 3-18, p<.001). Military-affiliated patients had a longer LOS of 4 days (IQR 2-11) vs 2 days (IQR 1-7, p=0.041), increased morbidities/complications (3 vs 2 counts, p=0.002), and a higher mortality rate (10% vs 4%, p=0.048). There was no significant difference in number of consults or injuries, trauma activation, or need for surgery. Conclusion: Military-affiliated children diagnosed with NAT experience more adverse outcomes than civilian patients. Increased LOS, morbidities/complications, and mortality suggest military-affiliated patients experience more life-threatening NAT at a younger age. Larger studies are required to further examine this population and better support at-risk families.