Injury patterns of child abuse: Experience of two Level 1 pediatric trauma centers

Purpose: This study examines non-accidental trauma (NAT) fatalities as a percentage of all injury fatalities and identifies injury patterns in NAT admissions to two level 1 pediatric trauma centers. Methods: We reviewed all children (< 5 years old) treated for NAT from 2011 to 2015. Patient demographics, injury sites, and survival were obtained from both institutional trauma registries. Results: Of 4623 trauma admissions, 557 (12%) were due to NAT. However, 43 (46%) of 93 overall trauma fatalities were due to NAT. Head injuries were the most common injuries sustained (60%) and led to the greatest increased risk of death (RR 5.1, 95% CI 2.0–12.7). Less common injuries that increased the risk of death were facial injuries (14%, RR 2.9, 95% CI 1.6–5.3), abdominal injuries (8%, RR 2.8, 95% CI 1.4–5.6), and spinal injuries (3%, RR 3.9, 95% CI 1.8–8.8). Although 76% of head injuries occurred in infants < 1 year, children ages 1–4 years old with head injuries had a significantly higher case fatality rate (27% vs. 6%, p < 0.001). Conclusion: Child abuse accounts for a large proportion of trauma fatalities in children under 5 years of age. Intracranial injuries are common in child abuse and increase the risk of death substantially. Preventing NAT in infants and young children should be a public health priority. Type of study: Retrospective Review.