Researchers from Columbus, OH aimed to compare mortality rates between children who were victims of initial episodes of nonaccidental trauma (NAT) to rates in those who were victims of recurrent episodes of NAT. The investigators also sought to identify factors associated with either NAT recurrence or increased mortality from recurrent NAT. For the study, data from the State of Ohio Trauma Registry (OTR) were reviewed to identify all patients <16 years of age hospitalized between 2000 and 2010 with an ICD-9 code for child abuse. Patients were identified as victims of recurrent NAT if they had 2 or more separate medical records of child abuse. As the OTR contains de-identified information, probabilistic linkage was used to identify recurrent admissions. Records with a perfect match for date of birth, sex, and race, and where death did not occur before the second record date, were assumed to belong to a single patient and represent recurrent visits.
Records were dichotomized into patients with single (initial) episodes of NAT and those with recurrent episodes, and these groups were compared. Additionally, the entire data set was dichotomized into survivors of NAT and nonsurvivors of NAT, and these groups were compared.
A total of 1,572 patients with NAT were identified during the study period, 53 (3.4%) with recurrent NAT and 1,519 with single episodes of NAT. Compared to children with a single episode of NAT, patients with recurrent NAT were more commonly male, more likely to be white, and more likely to be evaluated at a pediatric trauma center during their first episode of abuse. Those with recurrent NAT had higher mortality (24.5% vs 9.9%, P = .002) than those with a single episode. Of the 53 patients with recurrent abuse, there was no difference between survivors and nonsurvivors with regard to age, sex, or whether the child was treated at a pediatric trauma center; however, among patients with recurrent NAT, black patients more commonly suffered mortality than non-black patients (57% vs 20%, P = .05). The most common injuries at initial presentation of patients with recurrent NAT included skull fractures, subdural hematomas, rib fractures, contusions, and extremity fractures.
The authors conclude that recurrent NAT imparts an increased risk of death when compared to initial episodes of NAT.
Dr Anderst has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
This study adds to the growing literature indicating that medical professionals and governmental systems do not adequately detect, report, and prevent recurrent abuse.1–3 Use of the OTR database has limitations, since the database does not include children who died at the scene, or who were observed for less than 48 hours. Despite these limitations, the results...