Inflicted versus unintentional injury: towards improved detection and surveillance of supervisory neglect

Notrica, David M.; Sayrs, Lois W.; Kirsch, Lisa; Kelly, Cara; Nickoles, Todd; Greenberg, Jodie; Valdez, Maria Monserrat; Fernandez, Andrea C.; Krishna, Nidhi; Misra, Shivani

doi:10.1016/j.jpedsurg.2019.10.010

Cited by 11 publications

(11 citation statements)

References 9 publications

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“…In prior years, younger children and toddlers would typically be in some form of school or daycare. Removing younger children from this supervised environment and placing them in a possibly less controlled home environment, particularly when parents and caregivers are juggling other responsibilities such as work, may increase their risk of injury resulting in fracture compared to prior years [ 33 ]. Younger children are also less likely to be participating in sports than their older counterparts as the average age at which children enter organized sports is about 6–8 years old [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…While waiting for education systems to catch up with virtual learning demands, parents struggled to find sources of supervision and entertainment for their children. Compared to organized sports programs and schools where safeguards, supervision, and often medical interventions are in place, children at home may be unsupervised and have access to recreational equipment that can be risky when misused [ 33 ]. Human-powered and motorized vehicles such as bicycles, scooters, and skateboards are particularly prevalent mechanisms of injury among pediatric patients and in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Human-powered and motorized vehicles such as bicycles, scooters, and skateboards are particularly prevalent mechanisms of injury among pediatric patients and in this study. Growing instances of these mechanisms are likely due in part to the recent surge of e-scooter/bicycle sharing apps, and their subsequent increased availability to a broader population [ 33 , 36 , 37 ]. Trampolines are another frequent source of high-energy fractures among children.…”

Section: Discussionmentioning

confidence: 99%

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Multi-day delay to care identified in pediatric trauma cases during COVID-19

Shaw

Salton

Carry

et al. 2021

Journal of Pediatric Orthopaedics B

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This study aims to establish how pediatric fracture patterns were altered at a level 1 trauma center in a state that implemented a shutdown during the initial height of COVID-19. After IRB approval, we identified 2017 patients treated at a pediatric institution for definitive management of a fracture between 26 March and 31 May 2018, 2019, or 2020. Dates were chosen based on statewide stay-at-home orders for Colorado. Patients were excluded for treatment at another institution ( n = 148), no fracture noted in clinic ( n = 18), or other ( n = 13). Data were retrospectively collected from the remaining 1838 patients regarding demographics, fracture injury, mechanism, and treatment. Odds ratios (ORs) were calculated for each variable during COVID-19 relative to prior years. The number of fractures during 2020 decreased by 26% relative to 2019 and 23% to 2018. A larger proportion of patients experienced at least a 5-day delay to definitive treatment [OR: 1.55, confidence interval (CI): 1.23–1.96, P = 0.0002]. Rates of non-accidental trauma (NAT) increased non-significantly (OR: 2.67, CI: 0.86–8.32, P = 0.0900) during 2020 (1.2%) relative to 2018 (0.6%) and 2019 (0.3%). Fractures occurring at home increased to 79.9% (OR: 6.44, CI: 5.04–8.22, P < 0.0001). Despite less overall trauma during shelter-in-place orders, greater fracture numbers were seen among younger children and severe fractures were likely among older children. Patients may hesitate to seek care during 2020. Rates of NAT doubled during 2020. As communities prepare for future waves, treatment centers should warn against common fracture mechanisms and raise awareness of NAT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multi-day delay to care identified in pediatric trauma cases during COVID-19

Shaw

Salton

Carry

et al. 2021

Journal of Pediatric Orthopaedics B

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“…We also found isolated head fractures were associated with a 50% reduction of AHT as a mechanism for the injury. Research suggests skull fractures are more likely associated with noninflicted injury than AHT because the fracture is often associated with fall as the MOI (Hymel et al, 2014; Notrica et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma

Sayrs

Ortiz

Notrica

et al. 2020

J Interpers Violence

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Over half of fatal pediatric traumatic brain injuries are estimated to be the result of physical abuse, i.e., abusive head trauma (AHT). Although intimate partner violence (IPV) is a well-established risk for child maltreatment, little is known about IPV as an associated risk factor specifically for AHT. We performed a single-institution, retrospective review of all patients (0–17 years) diagnosed at a Level 1 pediatric trauma center with head trauma who had been referred to an in-hospital child protection team for suspicion of AHT between 2010 and 2016. Data on patient demographics, hospitalization, injury, family characteristics, sociobehavioral characteristics, physical examination, laboratory findings, imaging, discharge, and forensic determination of AHT were extracted from the institution’s forensic registry. Descriptive statistics (mean, median), chi-square and Mann–Whitney U tests were used to compare patients with fatal head injuries to patients with nonfatal head injuries by clinical characteristics, family characteristics, and forensic determination. Multiple logistic regression was used to estimate adjusted odds ratios for the presence of IPV as an associated risk of AHT while controlling for other clinical and family factors. Of 804 patients with suspicion for AHT in the forensic registry, there were 240 patients with a forensic determination of AHT; 42 injuries were fatal. There were 101 families with a reported history of IPV; 64.4% of patients in families with reported IPV were <12 months of age. IPV was associated with a twofold increase in the risk of AHT (Exp( β) = 2.3 [ p = .02]). This study confirmed IPV was an associated risk factor for AHT in a single institution cohort of pediatric patients with both fatal and nonfatal injuries. Identifying IPV along with other family factors may improve detection and surveillance of AHT in medical settings and help reduce injury, disability, and death.

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“…However, none of these studies included specific neglect diagnoses distinct from abuse when identifying children who experienced maltreatment. This is important as neglect may result in injuries due to improper supervision or unsafe environments ( Damashek et al, 2014 ; Notrica et al, 2020) and is more common than physical abuse ( US Department of Health and Human Services, 2020 ). Further, two of the studies only utilized data regarding pediatric hospital encounters (i.e., inpatient, emergency department, ambulatory surgery, and observation data) to identify cases of both abuse and minor injuries ( Lindberg et al, 2015 ; Puls et al, 2018 ), thereby missing both abuse and injury diagnoses made in outpatient settings, which may be both more common and less severe than those diagnosed in an inpatient setting.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect

2021

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Prior research has identified common injuries among children who experience child maltreatment; however, most of this work has focused on inpatient settings and has excluded many cases of neglect. This study examines the prevalence of injuries that occur prior to a diagnosis of child maltreatment, as well as the proportion of children with well-child visits prior to the injury and child maltreatment diagnosis. Based on a secondary analysis of Medicaid data from four states, we found that among infants with 12 months of continuous enrollment ( N = 4817), 30.6% of those diagnosed with maltreatment were previously diagnosed with an injury. Among infants diagnosed with child maltreatment, 88.4% had at least one well-child visit prior to the maltreatment diagnosis. Among children with a maltreatment diagnosis and a prior injury, 84% had at least one well-child visit preceding the injury. These results indicate that most children had at least one well-child visit prior to being diagnosed with child maltreatment or an injury, indicating opportunities for prevention.

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Inflicted versus unintentional injury: towards improved detection and surveillance of supervisory neglect

Cited by 11 publications

References 9 publications

Multi-day delay to care identified in pediatric trauma cases during COVID-19

Multi-day delay to care identified in pediatric trauma cases during COVID-19

Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma

Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect

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