Abstract
BackgroundMany children who are victims of non-accidental trauma (NAT) may be repeatedly evaluated for injuries related to maltreatment. The purpose of this study was to identify risk factors for repeated injuries in children with suspected NAT.MethodsWe conducted a retrospective cohort study using claims data from a pediatric Medicaid accountable care organization. Children with birth claims and at least one non-birth related claim indicating a diagnosis of NAT or skeletal survey in 2007–2011 were included. Recurrent events were defined as independent episodes of care involving an urgent/emergent care setting that included a diagnosis code specific for child abuse, a CPT code for a skeletal survey, or a diagnosis code for an injury suspicious for abuse. Cox proportional hazards models were used to examine risk factors for recurrent events.ResultsOf the 1,361 children with suspected NAT, a recurrent NAT event occurred in 26% within 1 year and 40% within 2 years of their initial event. Independent risk factors for a recurrent NAT event included a rural residence, age < 30 months old, having only 1 or 2 initially detected injuries, and having a dislocation, open wound, or superficial injury at the previous event (p ≤ 0.01 for all).ConclusionsOver 25% of children who experienced a suspected NAT event had a recurrent episode within one year. These children were younger and more likely to present with “minor” injuries at their previous event.
Highlights
Many children who are victims of non-accidental trauma (NAT) may be repeatedly evaluated for injuries related to maltreatment
We identified all children with a birth record claim who had at least one claim indicating a diagnosis of abuse or a skeletal survey at a non-birth related episode of care. (Figure 1) Suspected NAT events were defined as episodes of care in which a claim contained either (a) an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis code specific for child abuse, (b) a Current Procedural Terminology (CPT) coded skeletal survey, or (c) ICD-9 coded injuries suspicious for abuse; these events could be the event that brought the child into the study cohort, or they could occur either before or after that event
After removing events with diagnosis codes for a medical illness or trauma mechanism that could potentially explain the injuries, the cohort was further refined to 1,361 children who were included in the main analysis (Figure 1)
Summary
Many children who are victims of non-accidental trauma (NAT) may be repeatedly evaluated for injuries related to maltreatment. Reported predictors of recurrent NAT include prior child protective services involvement, history of domestic violence, chronicity of maltreatment, child’s age, parental history of maltreatment as a child, and parental substance abuse, criminal record, and mental health issues, or after specific injuries [5,6,9,10,11,12,13]. These previous studies are limited in that they either do not assess risk factors related to trauma, such as sentinel traumatic events, or they do not address recurrence of maltreatment.
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