Circumstances of injury in children with abusive versus non-abusive injuries

Abstract

BackgroundAlthough previous studies have examined differences in the characteristics of abusive versus non-abusive injuries, no study has focused on the differences in the circumstances surrounding these injuries, such as whether the event that caused the injury was witnessed or heard, or EMS was called. ObjectiveTo determine predictors related to the circumstances of the injury (COI) for distinguishing abusive versus non-abusive injuries. Participants/settingChildren younger than 3-years-old who were hospitalized with either a head injury or a fracture and evaluated by the child abuse consultation service between June 1, 2008 and June 30, 2017. MethodsIn this case-control study, abusive (cases) and non-abusive (controls) injuries were determined by a consensus of two experts blinded to the COI. Multivariable logistic regression was used to identify COI predictors of abusive injuries. ResultsWe identified 302 children: 80 cases (26.5%) and 222 controls (73.5%). Abused children were less likely to have a clear event described (p < .001). Of the 251 with a clear event, we found that the significant variables for abuse were father's presence (adjusted odds ratio [aOR] 8.37; 95% CI 3.35–20.92), delay ≥24 h in seeking care (aOR 6.23; 95% CI 1.95–19.92) and calling EMS (aOR 3.21; 95% CI 1.10–9.36). In contrast, the event being heard (aOR 0.22; 95% CI 0.08–0.0.59) and the child being dropped (aOR 0.09; 95% CI 0.01–0.77) were less likely to be abusive. ConclusionWe identified five COI predictors that may help clinicians in determining whether a child's injuries are due to abuse.