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Understanding non-accidental trauma in the United States: A national trauma databank study.

Abstract：

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. METHODS:Children <15 years presenting after NAT were identified in the 2007-2014 National Trauma Databank research datasets. Clinical and outcome data were analyzed using descriptive statistics, chi-square and logistic regression. RESULTS:Of 678,503 children admitted for traumatic injuries, 3% (19,149) were victims of NAT. The majority (95%) were under 5 years and 71% under 1 year old. The majority (59%) were male. The median injury severity score (ISS) was 10 (IQR:5-19). African Americans were disproportionally affected (27% vs 17% of all traumas), and the majority had public or no insurance (85%). Incidence was highest in the midwest and lowest in the northeast regions of the country, although trends varied over time. NAT resulted in 43% of trauma deaths in children <1 year and 31% of trauma deaths in children <5. Traumatic brain injury (TBI) was the most commonly encountered diagnosis (50%). Polytrauma was common, and certain injury patterns were identified. Urgent operation was required in 6%, 43% were admitted to intensive care, and 9% died. Mortality was independently associated with TBI, thoracic injury, hollow viscus injury and older age. CONCLUSION:Non-accidental trauma is a leading cause of trauma mortality in young children. Multiple injuries are common, requiring comprehensive evaluation and early surgical involvement. The data presented in this study could serve as a guide to target injury prevention efforts. LEVEL OF EVIDENCE:III STUDY TYPE: Prognostic and Epidemiological.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Rosenfeld EH,Johnson B,Wesson DE,Shah SR,Vogel AM,Naik-Mathuria B

doi

10.1016/j.jpedsurg.2019.03.024

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

693-697

issue

4

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(19)30335-5

journal_volume

55

pub_type

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