Trends in Hospitalization Rates and Severity of Injuries From Abuse in Young Children, 1997–2009

Abstract

OBJECTIVES: To examine trends in incidence of hospitalizations for injury from abuse in young children from 1997 through 2009 and to examine injury severity trends. METHODS: Cases were identified in the National Inpatient Sample database of the Healthcare Cost and Utilization Project by using International Classification of Diseases, Ninth Revision, Clinical Modification codes for child maltreatment and external cause of injury for assault in children aged 0 through 3 years. Incidence was calculated by age, gender, and region. Trends in incidence of hospitalization and injury severity were calculated over time. RESULTS: Hospitalization rates for injury from abuse showed no significant change over the study period, ranging from a low of 2.10 per 10 000 children in 1998 to a high of 3.01 per 10 000 children in 2005 (P = .755). Children aged <1 had significantly higher hospitalization rates for injury from abuse (6.01 vs 1.12, P <.001) and higher mean injury severity scores compared with children aged 1 to 3 years (12.50, SD = 0.14 vs 8.56, SD = 0.21, P <.001). Injury severity scores increased significantly over the study period. CONCLUSIONS: No significant change in hospitalization rates for injury from abuse among young children was observed from 1997 to 2009. These results coincide with other reports of stable or modestly increasing rates of serious physical abuse or death in young children but not with reports from child welfare data showing declines in physical abuse during the same period. Diverse sources of data may provide important complementary methods to track child abuse.

Potential Opportunities for Prevention or Earlier Diagnosis of Child Physical Abuse in the Inpatient Setting

“…Child physical abuse (CPA) remains a prevalent problem with the rates of abuserelated hospitalizations, abusive head trauma (AHT), and fatalities remaining stable or increasing in recent years. [1][2][3][4] Primary prevention is directed toward the general population and attempts to stop maltreatment from occurring. 5 Hospitalbased primary prevention efforts have principally targeted newborns during their birth hospitalizations.…”

Trends in Hospitalizations and Resource Utilization for Pediatric Pertussis

“…The use of weighted numbers in analysis, as done in our study, accounts for most selection bias, and several studies have used HCUP KID data for trend observations. 22,24–26 HCUP KID does not contain unique patient identifiers or record linkages, thereby preventing analysis of utilization according to detailed patient characteristics. It is also possible that 1 patient contributed to multiple discharges.…”

Critical Violent Injury in the United States

“…Men have higher violent injury and mortality rates than women (3,(5)(6)(7). From infancy into adulthood, AfricanAmericans experience higher rates of violent injury than Whites, with homicide as the leading cause of death for AfricanAmericans aged 15-24 years.…”

“…Every year in the United States, more than 3 million referrals of child maltreatment are received by state and local agencies, nearly six referrals every minute (15). An increase in abuse-related hospital admissions has been seen in recent years (16), with approximately 3,700 children hospitalized in the United States every year for injury from abuse, with most of those being neonates and infants 1-3 months old (6). The most common injuries are head trauma, abdominal injury, burn, fracture, asphyxia/ drowning, oral injury, and bruise (17)(18)(19).…”