Using US Data to Estimate the Incidence of Serious Physical Abuse in Children

Leventhal, John M.; Martin, Kimberly; Gaither, Julie R.

doi:10.1542/peds.2011-1277

Cited by 101 publications

(82 citation statements)

References 9 publications

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“…Consistent with other work, infants comprised the predominant proportion (65%) of young children who were admitted for injury from abuse. 18,19 Also consistent with other findings, children who were black, had public insurance or no insurance, and those from lowerincome neighborhoods, when compared with white children, privately insured, and those from higher-income areas, were more likely to be admitted for injury from abuse than for other reasons for admission. 9,18,20,21 The severity of injuries of hospitalized children increased slightly but significantly over the study period.…”

Section: Discussionsupporting

confidence: 79%

“…4,11,19 Hospital discharge data has been used to describe trends in hospitalizations of infants with traumatic brain injury, 9 track deaths related to child abuse, 10 and establish the incidence of conditions resulting from intentional injury such as abdominal trauma 23 and fractures. 12 Hospital discharge data have been proposed for use in a system to monitor the incidence of inflicted traumatic brain injury over time 11 and to monitor trends in serious physical abuse as a means to evaluate effects of prevention programs.…”

Section: Discussionmentioning

confidence: 99%

“…12 Hospital discharge data have been proposed for use in a system to monitor the incidence of inflicted traumatic brain injury over time 11 and to monitor trends in serious physical abuse as a means to evaluate effects of prevention programs. 4,19 Hospital discharge databases using ICD-9 codes allow the use of E-codes for assault to better identify cases of inflicted injury and injury severity scoring to judge the seriousness of the child' s abuse. 12,13,24 Our study population was limited to children 0 through 3 years of age because this represents the age group most likely to require hospitalization for injury from abuse.…”

Section: Discussionmentioning

confidence: 99%

“…12,13,24 Our study population was limited to children 0 through 3 years of age because this represents the age group most likely to require hospitalization for injury from abuse. 18,19 Limiting the study population to the youngest age group also minimizes the potential confounder of an E-code for assault representing peer on peer violence in older age groups instead of injury perpetrated by a person responsible for the child' s care although serious injury can occur to young children by their siblings. The percentage of cases identified by E-code alone was stable during the study period, which is consistent with published data supporting relative stability of E-coding since 1997.…”

Section: Discussionmentioning

confidence: 99%

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

Farst

Ambadwar²,

King³

et al. 2013

Pediatrics

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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.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Farst

Ambadwar²,

King³

et al. 2013

Pediatrics

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“…In the study of Leventhal et al (27) published in 2012, all patients below the age of 18 years hospitalized in 2006 in USA were examined and it was found that 4569 patients were hospitalized because of child abuse and 300 of these resulted in mortality. In one study conducted in Turkey, the rate of presentation because of child abuse among forensic cases below the age of 17 years was found to be 0.8%.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of forensic cases admitted to pediatric intensive care unit

Duramaz¹,

Yıldırım²,

Kıhtır³

et al. 2015

Turk Pediatri Ars

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Aim: This study aimed to determine the epidemiological and clinical characteristics of pediatric forensic cases to contribute to the literature and to preventive health care services. Material and Methods:Pediatric forensic cases hospitalized in our pediatric intensive care unit below the age of 17 years were reviewed retrospectively (January 2009-June 2014) . The patients were evaluated in two groups as physical traumas (Group A) and poisonings (Group B). The patients' age, gender, complaints at presentation, time of presentation and referral (season, time) and, mortality rates were determined. Cases of physical trauma (Group A) were classified as traffic accidents, falling down from height, falling of device, drowning, electric shock, burns and child abuse. Poisonings (Group B) were classified as pharmaceuticals, pesticides, other chemicals and unknown drug poisonings.Results: Two hundred twenthy cases were included. The mean age was 5.1+3.1 years. One hundred fifteen (%52.5) of the cases were male and 105 (%47.5) were female. Group A consisted of 62 patients and Group B consisted of 158 patients. The patients presented most frequently in summer months. The most common reason for presentation was falling down from height (12.7%) in Group A and accidental drug poisoning (most frequently antidepressants) in Group B. The mortality rate was 5%. Conclusion:Forensic cases in the pediatric population (physical trauma and poisoning) are preventable health problems. Especially, preventive approach to improve the environment for falling down from height must be a priority. Increasing the awareness of families and the community on this issue, in summer months during which forensic cases are observed most frequently can contribute to a reduction in the number of cases. (Turk Pediatri Ars 2015; 50: 145-50)

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Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment

Salimi-Jazi,

Liang,

Huang

et al. 2024

JAMA Netw Open

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ImportanceChild abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging.ObjectiveTo describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury.Design, Setting, and ParticipantsThis retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged &lt;18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids’ Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024.ExposureThe SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment.Main Outcome and MeasureThe primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA.ResultsAmong the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P &lt; .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P &lt; .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P &lt; .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P &lt; .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (P &lt; .001) for serious injury.Conclusion and RelevanceIn this study, Black children and adolescents were suspected to have experienced child abuse at higher rates than children and adolescents of other racial and ethnic backgrounds. More research is necessary to understand the origins of these disparities to reduce them in child abuse identification.

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Using US Data to Estimate the Incidence of Serious Physical Abuse in Children

Cited by 101 publications

References 9 publications

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

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

Evaluation of forensic cases admitted to pediatric intensive care unit

Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment

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