C. N. Litz1, P. D. Danielson1, N. M. Chandler1 1Johns Hopkins All Children’s Hospital,Division Of Pediatric Surgery,St. Petersburg, FL, USA
Introduction: Suspected non-accidental trauma (NAT) victims comprise a significant portion of the pediatric trauma population. There is no gold standard method of confirming NAT; instead, the diagnosis is made after a comprehensive evaluation by a child protective services (CPS) team. The purpose of this study was to compare the clinical and social outcomes between patients with suspected NAT (SUSP) and confirmed NAT (CONF).
Methods: Following IRB approval (No. 00082930), our institutional trauma registry was retrospectively reviewed for patients aged 0-18 years presenting from 2007 to 2012. Patients with traumatic injuries suspicious for NAT were included. NAT was diagnosed after evaluation by our CPS team. Patients with suspected and confirmed NAT were compared. General admission and outcome data were collected and analyzed.
Results: There were 281 patients with traumatic injuries suspicious for NAT; 170 were CONF and 111 SUSP. The groups did not differ in age (CONF 0.9 ± 1.1 vs SUSP 1.2 ± 2 years, p=0.16). CONF patients presented with a higher heart rate (142 ± 27 vs 128 ± 23 bpm, p<0.0001), lower systolic blood pressure (100 ± 18 vs 105 ± 16 mm Hg, p < 0.05), lower Glasgow Coma Score (12 ± 4 vs 15 ± 1, p <0.0001), and a higher Injury Severity Score (15 ± 11 vs 9 ± 5, p<0.0001). A significantly greater percentage of CONF patients were admitted to the intensive care unit (42% vs 8%, p<0.0001). CONF patients had significantly higher mortality (8.2% vs 0%, p<0.0001). CONF patients had a significantly longer overall length of stay (LOS) (7.8 ± 9.8 vs 1.6 ± 1.3 days, p <0.001), as well as a longer LOS after being medically cleared for discharge (1.2 ± 1.7 vs 0.2 ± 0.4 days, p<0.0001). Significantly fewer CONF patients were discharged with parents or other family members (54% vs 100%, P<0.0001) (Table 1).
Conclusion: Patients with a confirmed diagnosis of NAT present with more severe injuries and arrive less hemodynamically stable compared to patients in whom NAT is suspected and ruled out. In addition, patients with confirmed NAT require increased hospital resources and are less likely to be discharged to the care of parents or family members. This study emphasizes the fact that NAT patients are a high-risk subset of the pediatric trauma population, and suggests that providers should have an increased suspicion for true non-accidental trauma in patients being evaluated for possible NAT who present with more severe injuries.
