Non-accidental Trauma Injury Patterns and Outcomes: A Single Institutional Experience

Ward, Austin; Iocono, Joseph A.; Brown, Samuel; Ashley, Phillip Spencer; Draus, John M.

doi:10.1177/000313481508100912

Cited by 30 publications

(19 citation statements)

References 6 publications

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“…Almost all children were transported to the hospital via ambulance or by a parent/guardian, with a majority of the injuries occurring between the hours of 4pm and 4am. Injury severity scores were comparable between children in our 2 age groups and are similar to previous literature [24]. More older children in our study were intubated upon arrival compared to the ≤6 month old group, which when used as a measure of injury severity, is contrary to prior findings where younger victims of NAT had more severe injuries [30].These differences in results could be attributed to the power of the present study, since the aforementioned investigation included more than 2,500 patients.…”

Section: Injury Presentation Diagnosis and Dispositionsupporting

confidence: 91%

“…The most prevalent locations of final injuries were the head, extremity, and abdomen/pelvis, similar to prior findings [24,31]. In over one half of the patients, NAT was confirmed resulting in removal of a child from the custody of at least one parent/guardian.…”

Section: Injury Presentation Diagnosis and Dispositionsupporting

confidence: 80%

“…The most common fractures identified on the skeletal surveys were those of the long bone (50%), torso (30%), and skull (13%), with no differences noted between age groups. This pattern of injury follows similar trends previously reported [22,23,24]. For example, in a retrospective study reviewing all patients with NAT at a Pediatric Trauma Center in Texas over the period between 2007 and 2011, investigators identified 267 patients who presented with over 473 injuries.…”

Section: Utility and Findings Of Skeletal Surveysupporting

confidence: 78%

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Diagnostic Yield of Skeletal Survey in Pediatric Trauma Patients by Age

Green

Hazeltine

Damle

et al. 2018

IPCC

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Introduction: Non-accidental Trauma (NAT) is a major cause of morbidity and mortality in children. Younger children are at greater risk of NAT. In this observational study, we determine if there is an association between a child’s age, frequency of positive of skeletal surveys and the types of injuries discovered in pediatric patients undergoing a trauma work up. Methods: The study sample consisted of all pediatric trauma patients < 3 years old, who had skeletal surveys performed at a tertiary care center between 2005 and 2015. Patients were divided into two age groups: ?6months old (n=98) and >6months old (n=86). The utilization of a skeletal survey, frequency of confirmed NAT, and injuries were compared between these 2 age groups. Results: The average age of this population was 8.4 months, 56.0% were boys, and 62.5% were Caucasian. A positive skeletal survey was found in 14.3% of patients ?6months old and 18.6% of patients >6months old (p=0.43). The most common fractures identified were long bone (50.0%), torso (30.4%), and skull (13.0%). Similar frequencies of NAT were observed between those less than and older than 6 months (58.2% vs. 57.0%). Head computed tomography (CT) scans were performed in the majority (95.9%) of patients ?6 months old and in 66.3% of patients >6 months old (p < 0.01). Conclusion: Skeletal surveys identify additional injuries at comparable rates in pediatric trauma patients regardless of age. Advanced imaging differs in younger and older pediatric trauma patients undergoing skeletal survey.

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Section: Injury Presentation Diagnosis and Dispositionsupporting

confidence: 91%

Section: Injury Presentation Diagnosis and Dispositionsupporting

confidence: 80%

Section: Utility and Findings Of Skeletal Surveysupporting

confidence: 78%

See 1 more Smart Citation

Diagnostic Yield of Skeletal Survey in Pediatric Trauma Patients by Age

Green

Hazeltine

Damle

et al. 2018

IPCC

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“…Studies have been published using data from individual hospitals across the world, but the significant majority come from the USA 15. It has been noted that findings vary quite widely between centres,4 16 17 suggesting that detection of physical abuse varies in incidence between geographic areas. While it can take place in any family, it occurs more frequently in areas with social challenges, with complex interplay between social deprivation, income inequality, mental health problems, alcohol and substance misuse and domestic abuse 18–20…”

Section: Introductionmentioning

confidence: 99%

Multicentre study of physical abuse and limb fractures in young children in the East Anglia Region, UK

et al. 2019

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ObjectiveTo determine if the detection of physical abuse in young children with fractures is of uniform high standard in the East Anglia Region of the UK, and whether we can identify areas for improvement in our detection of high-risk groups.DesignMulticentre retrospective 4-year study.Setting7 hospitals across the East Anglia Region of Britain (East Anglia Paediatric Physical Abuse and Fractures study).ParticipantsAge groups and fractures indicated as being at higher risk for physical abuse (all children under 12 months of age, and fractures of humerus and femur in children under 36 months of age).Outcome measuresOur criterion for physical abuse was the decision of a multiagency child protection case conference (CPCC).ResultsProbability of CPCC decision of physical abuse was highest in infants, ranging from 50% of fractures sustained in the first month of life (excluding obstetric injuries) to 10% at 12 months of age. Only 46%–86% of infants (under 12 months) with a fracture were assessed by a paediatrician for physical abuse after their fracture. Significant variation in the use of skeletal surveys and in CPCC decision of physical abuse was noted in children attending different hospitals.ConclusionsIt is a concern that significant variation between hospitals was found in the investigation and detection of physical abuse as confirmed by CPCC decisions. To minimise failure to detect true cases of physical abuse, we recommend that all high-risk children should be assessed by a paediatrician prior to discharge from the emergency department. Our proposed criteria for assessment (where we found probability of CPCC decision of physical abuse was at least 10%) are any child under the age of 12 months with any fracture, under 18 months of age with femur fracture and under 24 months with humeral shaft fracture (not supracondylar).

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“… 12 Abusive head trauma (AHT), or head injuries secondary to non-accidental trauma (NAT), are an especially vulnerable group—these injured children are known to have poor outcomes, with a higher rate of mortality and multiple injuries. 13 14 …”

Section: Introductionmentioning

confidence: 99%

A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study

et al. 2016

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ObjectiveTo study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention.DesignThis is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015.SettingPaediatric emergency departments (EDs) of KK Women's and Children's Hospital and the National University Health System.ParticipantsWe included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved.Primary and secondary outcome measuresPrimary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention.ResultsWe analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints.ConclusionsMotor vehicle crashes and non-accidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital.

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Non-accidental Trauma Injury Patterns and Outcomes: A Single Institutional Experience

Cited by 30 publications

References 6 publications

Diagnostic Yield of Skeletal Survey in Pediatric Trauma Patients by Age

Diagnostic Yield of Skeletal Survey in Pediatric Trauma Patients by Age

Multicentre study of physical abuse and limb fractures in young children in the East Anglia Region, UK

A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study

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