Abstract

ObjectivesTo describe nationally representative outcomes of physical abuse injuries in children necessitating Emergency Department (ED) visits in United States. The impact of various injuries on mortality is examined. We hypothesize that physical abuse resulting in intracranial injuries are associated with worse outcome.Materials and MethodsWe performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS), the largest all payer hospital based ED database, for the years 2008–2010. All ED visits and subsequent hospitalizations with a diagnosis of “Child physical abuse” (Battered baby or child syndrome) due to various injuries were identified using ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes. In addition, we also examined the prevalence of sexual abuse in this cohort. A multivariable logistic regression model was used to examine the association between mortality and types of injuries after adjusting for a multitude of patient and hospital level factors.ResultsOf the 16897 ED visits that were attributed to child physical abuse, 5182 (30.7%) required hospitalization. Hospitalized children were younger than those released treated and released from the ED (1.9 years vs. 6.4 years). Male or female partner of the child’s parent/guardian accounted for >45% of perpetrators. Common injuries in hospitalized children include- any fractures (63.5%), intracranial injuries (32.3%) and crushing/internal injuries (9.1%). Death occurred in 246 patients (13 in ED and 233 following hospitalization). Amongst the 16897 ED visits, 1.3% also had sexual abuse. Multivariable analyses revealed each 1 year increase in age was associated with a lower odds of mortality (OR = 0.88, 95% CI = 0.81–0.96, p<0.0001). Females (OR = 2.39, 1.07–5.34, p = 0.03), those with intracranial injuries (OR = 65.24, 27.57–154.41, p<0.0001), or crushing/internal injury (OR = 4.98, 2.24–11.07, p<0.0001) had higher odds of mortality compared to their male counterparts.ConclusionsIn this large cohort of physically abused children, younger age, females and intracranial or crushing/internal injuries were independent predictors of mortality. Identification of high risk cohorts in the ED may enable strengthening of existing screening programs and optimization of outcomes.

Highlights

  • Child maltreatment occurs worldwide and is an important cause of morbidity and mortality. [1,10] In United States, child maltreatment includes any act which results in physical, emotional or sexual abuse; or failure to act resulting in imminent risk of harm, usually by a parent, caregiver or, occasionally, by an unknown perpetrator [2,3].Available estimates indicate that approximately 700,000 to 1.25 million children are abused or neglected annually in the United States [4,5,6] and about 18 percent of these cases involve physical abuse [7]

  • Of the 16897 Emergency Department (ED) visits that were attributed to child physical abuse, 5182 (30.7%) required hospitalization

  • Females (OR = 2.39, 1.07–5.34, p = 0.03), those with intracranial injuries (OR = 65.24, 27.57–154.41, p,0.0001), or crushing/internal injury (OR = 4.98, 2.24–11.07, p,0.0001) had higher odds of mortality compared to their male counterparts

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Summary

Introduction

Child maltreatment occurs worldwide and is an important cause of morbidity and mortality. [1,10] In United States, child maltreatment includes any act which results in physical, emotional or sexual abuse; or failure to act (neglect) resulting in imminent risk of harm, usually by a parent, caregiver or, occasionally, by an unknown perpetrator [2,3].Available estimates indicate that approximately 700,000 to 1.25 million children are abused or neglected annually in the United States [4,5,6] and about 18 percent of these cases involve physical abuse [7]. An estimated1.3% to 15% of injuries in children that result in emergency department visits are caused by physical abuse [8]. Early detection rate of child abuse in emergency departments varies among different countries (Netherlands: 0.2%, Italy 2%, the United Kingdom: 4%–6.4%, United States: 10%) [16,17,18,19,20,21] due to varied screening tools, emergency departments are important in the initial evaluation of suspected physical abuse in children [11,12,13,14,15]. Current national estimates and outcomes of physical abuse in children necessitating emergency department visit in United States are unclear

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