Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center.

Taylor Goldman,Sathyaprasad Burjonrappa,Samuel Menahem

doi:10.1155/2020/6621992

Taylor Goldman, Sathyaprasad Burjonrappa + Show 1 more

Open Access

https://doi.org/10.1155/2020/6621992

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Abstract

Introduction Pediatric nonaccidental trauma (NAT) is difficult to diagnose. Several isolated injuries in NAT could happen in the setting of accidental trauma (AT), and having a high index of suspicion is important to correctly identify abuse. NAT has a significant mortality rate if the sentinel event is not adequately diagnosed, and the infant is not separated from the perpetrator. Level 1 pediatric trauma centers (PTC) see a significant number of NAT. We evaluated the injury patterns of NAT admissions at our level 1 PTC. Methods Retrospective analysis of all cases of NAT for children under the age of two admitted at an ACS level 1 pediatric trauma center between the years of 2016 and 2018. Charts were queried for demographic data, injury patterns, mortality, and disposition. Correlation between disposition status and injury patterns was performed. The Fisher Exact test and student t-test were used to study the significance of differences in categorical and continuous data, respectively. Results 32/91 (35%) trauma patients under the age of two years were diagnosed as NAT in the three-year study period. 21/32 (39%) male and 11/26 (42%) female admissions were confirmed NAT (p = NS). 20 were under 1 year of age, and 12 were aged between 1 and 2 years (p = NS). 13 (41%) were Caucasian, 6 (19%) were Hispanic/Latino, 11 (34%) were Black, and 2(6%) were of unknown ethnicity (p = NS). Facial, torso, lower extremity, retinal, and internal organ injury were significantly more common with NAT. Medicaid coverage was noted in 31/32 (97%) NAT patients. 20/32 (62.5%) patients were legally displaced as a result of the NAT. Conclusion 1/3rd of all admissions at a pediatric level 1 trauma center were identified as NAT. A high index of suspicion is necessary to not miss NAT, as injury patterns are variable. Nearly 1/3rd of all victims go back to the same environment where they sustained NAT increasing their susceptibility to future NAT.

Highlights

Pediatric nonaccidental trauma (NAT) is difficult to diagnose
It is important for the healthcare providers to correctly identify risk factors and injury patterns in NAT so that appropriate authorities can take legal action to remove the child from an unsafe environment in the case of proven abuse
We strongly believe that based on our experience, each and every trauma victim in the 0-2 years age group should be screened for potential NAT

Summary

Introduction

Pediatric nonaccidental trauma (NAT) is difficult to diagnose. Several isolated injuries in NAT could happen in the setting of accidental trauma (AT), and having a high index of suspicion is important to correctly identify abuse. Level 1 pediatric trauma centers (PTC) see a significant number of NAT. 32/91 (35%) trauma patients under the age of two years were diagnosed as NAT in the three-year study period. 1/3rd of all admissions at a pediatric level 1 trauma center were identified as NAT. Victims who were previously treated for NAT had a 24.5% mortality rate, whereas victims who were only treated once had a 9.9% mortality rate [3] It is important for the healthcare providers to correctly identify risk factors and injury patterns in NAT so that appropriate authorities can take legal action to remove the child from an unsafe environment in the case of proven abuse. This study seeks to understand the demographics, injury patterns, and disposition patterns following NAT admission at a large urban pediatric level 1 trauma center

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