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Background: Parental, familial, and demographic risk factors for nonaccidental trauma (NAT) have been well-studied, but neonatal factors, such as comorbidities and prematurity have not. We assess the correlation of these factors with NAT.
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Background: Child abuse, or nonaccidental trauma (NAT), is a major cause of pediatric morbidity and mortality, and is often unrecognized. Our hypothesis was that injuries due to accidental trauma (AT) and NAT are significantly dif...
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Background: Child abuse, or nonaccidental trauma (NAT), is a major cause of pediatric morbidity and mortality, and is often unrecognized. Our hypothesis was that injuries due to accidental trauma (AT) and NAT are significantly different in incidence, injury, severity, and outcome, and are often unrecognized. Objective: Our aim was to carry out an examination of the differences between pediatric injuries due to AT and NAT regarding incidence, demographics, injury severity, and outcomes. Methods: A 4-year retrospective review of the Trauma Registry at Children's Medical Center Dallas, a large Level I pediatric trauma center, comparing incidence, age, race, trauma activation, intensive care unit (ICU) need, Injury Severity Score (ISS), and mortality between AT and NAT patients was carried out. Results: There were 5948 admissions, 92.5% were AT and 7.5% were NAT victims. The NAT patients were younger (1.8 +/- 3.3 years vs. 6.8 +/- 4.2 years for AT patients; p < 0.01), more often required an ICU stay (NAT 36.5% vs. 13.8% for AT patients; p < 0.0001), and had a higher ISS 14.0 +/- 9.7 vs. 7.5 +/- 7.2; p < 0.0001). The mortality rate in NAT was 8.9% vs. 1.4% for AT (p < 0.001). Of the 40 NAT patients who ultimately died, 17.5% were not initially diagnosed as NAT. Conclusions: NAT victims differ significantly from the AT patients, with a greater severity of injury and a 6-fold higher mortality rate. Delayed recognition of NAT occurred in almost 20% of the cases. It is generally accepted that NAT is underestimated. Its increased mortality rate and severity of injury are also not well recognized compared to the typical pediatric trauma child. (C) 2015 Elsevier Inc.
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BackgroundNonaccidental trauma (NAT) is a leading cause of injury and death in early childhood. We sought to understand the association between insurance status and mortality in a national sample of pediatric NAT patients. Materia...
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BackgroundNonaccidental trauma (NAT) is a leading cause of injury and death in early childhood. We sought to understand the association between insurance status and mortality in a national sample of pediatric NAT patients. Materials and methodsWe performed a retrospective cohort study using the 2012-2014 National Trauma Databank. We included children ≤18 y hospitalized with NAT (The International Classification of Diseases, Ninth Revision codes: E967-968). The primary exposure was insurance status (categorized as public, private, and uninsured). The primary outcome was emergency department or inpatient mortality from NAT. ResultsWe identified 6389 children with NAT. Mean age was 1.6?y (standard deviation 3.7), with 41% female and 42% of an ethnic or racial minority. Most were publicly insured (77%), with 17% privately insured and 6% uninsured. Mean injury severity score (ISS) was 13.9 (standard deviation 10.3). Overall, 516 (8%) patients died following NAT. Compared to patients who survived, those who died were more likely to be younger (mean age 1.0?yversus1.6?y;P?收起
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Background: The purpose of this study is to characterize the epidemiology, injury patterns, outcomes and trends of non-accidental trauma (NAT) in the United States using a large national database.
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Intimate partner violence and elder abuse are common in the United States but often remain undetected. The incidence of these forms of abuse is difficult to quantify, but those with a history of abuse are at risk of chronic health...
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Intimate partner violence and elder abuse are common in the United States but often remain undetected. The incidence of these forms of abuse is difficult to quantify, but those with a history of abuse are at risk of chronic health conditions. Physicians are in a unique position of triaging trauma patients and differentiating unintentional from abusive trauma in patients. Certain orthopedic injuries, in particular, may be related to abuse, which may trigger clinical suspicion and lead to further workup or intervention. By increasing awareness, through physician education and increased screening, earlier detection of abuse may prevent more serious injuries and consequences. Therefore, this review evaluates current literature regarding the orthopedic manifestations of abuse in hopes of increasing physician awareness. (C) 2020 Elsevier Inc. All rights reserved.
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Background: Epistaxis is a common emergency department (ED) complaint; however, this entity is rare among children younger than 2 years of age. In this age group, epistaxis may be a presenting sign of a bleeding disorder or nonaccidental trauma.
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ABSTRACT: A previously healthy toddler presented to the emergency department with nonspecific gastrointestinal complaints. Laboratory studies were consistent with pancreatitis, and imaging studies demonstrated a pancreatic transec...
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ABSTRACT: A previously healthy toddler presented to the emergency department with nonspecific gastrointestinal complaints. Laboratory studies were consistent with pancreatitis, and imaging studies demonstrated a pancreatic transection. Alopecia felt to be related to traction was also noted. There was no history of any witnessed trauma, and nonaccidental trauma was diagnosed.
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BACKGROUND: Child physical abuse (CPA) carries high risk of morbidity and mortality. Screening for CPA may be limited by subjective risk criteria and racial and socioeconomic biases. This study derived, validated, and compared age...
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BACKGROUND: Child physical abuse (CPA) carries high risk of morbidity and mortality. Screening for CPA may be limited by subjective risk criteria and racial and socioeconomic biases. This study derived, validated, and compared age-stratified International Classification of Diseases, 10th revision (ICD-10) diagnosis codes indicating high risk of CPA. METHODS: Injured children younger than 6 years from the Trauma Quality Improvement Program (TQIP) database were included; years 2017 to 2018 were used for derivation and 2019 for validation. Confirmed CPA was defined as a report of abuse plus discharge with alternate caregiver. Patients were classified as high vs. low CPA risk by three methods: (1) abuse-specific ICD-10 codes, (2) previously validated high-risk ICD-9 codes crosswalked to equivalent ICD-10 codes, and (3) empirically-derived ICD-10 codes from TQIP. These methods were compared with respect to sensitivity, specificity, area under the receiver-operator curve (AUROC), and uniformity across race and insurance strata. RESULTS: A total of 122,867 children were included (81,347 derivation cohort, 41,520 validation cohort). Age-stratified high-risk diagnoses derived from TQIP consisted of 40 unique codes for ages 0 year to 2 years, 30 codes for ages 3 years to 4 years, and 20 codes for ages 5 years to 6 years. In the validation cohort, 890 children (2.1%) had confirmed CPA. On comparison with abuse-specific and crosswalked ICD-9 codes, TQIP-derived codes had the highest sensitivity (70% vs. 19% vs. 54%) and the highest AUROC (0.74 vs. 0.59 vs. 0.68, p < 0.0001) for confirmed abuse across all age groups. Age-based risk stratification using TQIP-derived codes demonstrated low variability by race (25% White vs. 25% Hispanic vs. 28% Black patients considered high-risk) and insurance status (23% privately insured vs. 26% uninsured). CONCLUSION: High-risk CPA injury codes empirically derived from TQIP produced the best diagnostic characteristics and minimized some disparities. This approach, while requiring further validation, has the potential to improve CPA injury surveillance and decrease bias in screening protocols.
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