Consistent screening of admitted infants with head injuries reveals high rate of nonaccidental trauma

  • Paul T. Kim
    Affiliations
    Trauma Service, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH
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  • Jillian McCagg
    Affiliations
    Marshal University, 1 John Marshall Dr., Huntington, WV 25755
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  • Ashley Dundon
    Affiliations
    Trauma Service, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH
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  • Zach Ziesler
    Affiliations
    Trauma Service, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH
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  • Suzanne Moody
    Affiliations
    Trauma Service, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH
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  • Richard A. Falcone Jr.
    Correspondence
    Corresponding author at: Trauma Service, Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229. Tel.: +1 513 636 6652 (Work); fax: +1 513 636 7657.
    Affiliations
    Trauma Service, Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH
    Search for articles by this author

      Abstract

      Purpose

      Implementation of a nonaccidental trauma (NAT) screening guideline for the evaluation of infants admitted with an unwitnessed head injury has eliminated screening disparities. This study sought to determine the overall NAT rate and key predictive factors using this guideline.

      Methods

      All infants screened via the guideline from 2008 to 2015 were retrospectively reviewed. The overall rate of NAT as determined by our child abuse team was determined. In addition, a logistic regression model was developed to evaluate potential predictors of increased risk of NAT.

      Results

      A total of 563 infants were screened with an overall rate of NAT of 25.6% (n = 144). NAT screening was consistent across race and insurance status. By univariate analysis, patients with government insurance or no insurance had a significantly higher rate of NAT, but race was not a factor. Also NAT victims had significantly higher ISS. Skeletal survey showed high positive predictive value of 94%. When regression modeling was performed, ISS, abnormal skeletal survey and having public or no insurance were significantly correlated with NAT, while race showed no correlation.

      Conclusion

      One quarter of infants admitted with a head injury not witnessed in a public situation were identified as the victims of NAT. The high rate of abuse among this population supports routine screening in order to avoid missing intentional injuries and preventing future injuries. Race is not a predictor of NAT, but insurance status, as a proxy for socioeconomic status, is correlated, and further investigation is needed.

      Level of evidence

      III

      Abbreviations:

      NAT (nonaccidental trauma), CAT (Child Abuse Team), AA (African American), ISS (Injury Severity Score), AHT (abusive head trauma), SES (socioeconomic status)

      Key words

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