G325(P) Non accidental injury: are we missing the major traumas?

Abstract

Non accidental injury (NAI) is a recognised cause of trauma in children. Recently it has been found to be the fourth most common mechanism of injury in children with major trauma. Suspected child abuse is more likely in younger children. We aimed to evaluate the recognition of NAI in patients presenting to our Major Trauma centre (MTC) and how this affected their ongoing care. Methods Using the TARN database we selected patients under 1 presenting between 2012–2017. Available online records were then reviewed to assess whether Safeguarding proceedings had been started, or documented as having been considered. Results 74 patients were identified. 71.6% (n=53) underwent safeguarding proceedings. 13.5% (n=10) documented safeguarding was considered. 13.5% (n=10) had no documentation of safeguarding considerations. Median age of those undergoing safeguarding proceedings was 0.1, for those considered 0.4 and for those not documented 0.8. Median Injury Severity Scores when it was done or considered was 16; 9 for where there was no documentation. Of those attending the Emergency Department, trauma calls occurred in 20% where safeguarding was done, 25% where it was considered and 10% of those where it was not considered. 66% were head injuries; 73% of all cases where safeguarding proceedings occurred. 39 Patients undergoing safeguarding proceedings were found to have a significant head injury (29 with documented CT (computed tomography) times). 60% of patients who were trauma called had CT Head within first hour. In the non trauma called group this was 21%. Median time to CT (in hours) for those trauma called 0.7 hours. For those not trauma called 4.97 hours. Conclusions Safeguarding is considered in the majority of all trauma cases during their admission and is more likely with increasingly significant injuries and younger children. Early recognition of these patients being potential major trauma is low with a lack of trauma calls. This is likely due to different presentations (the drowsy/unwell baby), and different methods of arrival. This is reflected in the delay to CT times. We need to highlight the early recognition of the NAI patient as potential trauma to improve their management alongside non NAI trauma patients.