Child physical abuse trauma evaluation and management: A Western Trauma Association and Pediatric Trauma Society critical decisions algorithm

Rosen, Nelson G.; Escobar, Mauricio A.; Brown, Carlos; Moore, Ernest E.; Sava, Jack; Peck, Kimberly A.; Ciesla, David J.; Sperry, Jason L.; Rizzo, Anne G.; Ley, Eric J.; Brasel, Karen J.; Kozar, Rosemary A.; Inaba, Kenji; Hoffman-Rosenfeld, Jamie; Notrica, David M.; Sayrs, Lois W.; Nickoles, Todd; Letton, Robert W.; Falcone, Richard A.; Mitchell, Ian C.; Martin, Matthew J.

doi:10.1097/ta.0000000000003076

Cited by 14 publications

(22 citation statements)

References 41 publications

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“…Differences by site may also affect our results; each site likely has slightly different criteria for trauma activations or admissions and specific signs or symptoms that trigger a NAT diagnosis. 32 , 33 However, individual site criteria were unchanged during the study period and should not cause time-related variation. Further, all sites included in this study were in urban centers; while each site has a catchment area that includes rural areas, these results may not be able to be extrapolated to rural areas.…”

Section: Discussionmentioning

confidence: 99%

Association of Economic Recession and Social Distancing With Pediatric Non-accidental Trauma During COVID-19

Lewit

Kotagal

Falcone

et al. 2022

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 99%

Association of Economic Recession and Social Distancing With Pediatric Non-accidental Trauma During COVID-19

Lewit

Kotagal

Falcone

et al. 2022

Journal of Surgical Research

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“…To assist with detecting and distinguishing cases of abuse in children, multiple studies have focused on developing care and prediction algorithms 25,28. In 2021, the Western Trauma Association and Pediatric Trauma Society published a joint recommendation on a clinical decision algorithm for the management of children with concern for physical abuse 28.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, lack of community support available to parents, prior history of alcohol/drug abuse or violence, engagement in criminal activity, life stressors, or an impaired psychological state have each been found to lead to an increased likelihood of NAT. Given that families from all racial and socioeconomic backgrounds can be influenced by these factors, it is important for providers to continue to work towards limiting racial and socioeconomic bias when evaluating NAT 28,35,36…”

Section: Discussionmentioning

confidence: 99%

Nonaccidental Trauma in Pediatric Elbow Fractures: When You Should Be Worried

Tadepalli¹,

Schultz²,

Rees³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Nonaccidental trauma (NAT) is a rising source of morbidity and mortality in the pediatric population. Fractures are often the first cause for presentation to health care providers in the case of NAT but can be misidentified as accidental. Given that elbow fractures are the most common accidental injuries among pediatric patients, they are not traditionally associated with NAT. This study aims to determine the prevalence of NAT among elbow fractures and identify common features in nonaccidental elbow fractures. Methods: Current Procedural Terminology (CPT) codes were used to retrospectively identify all pediatric (0 to 17) elbow fractures at a single, tertiary children’s hospital between 2007 and 2017. Among these, all fractures for which an institutional child abuse evaluation team was consulted were identified. The medical record was then used to determine which of these fractures were due to NAT. Standard injury radiographs of all victims of NAT as well as all patients under 1 year of age were blinded and radiographically evaluated for fracture type by a pediatric orthopaedic surgeon. Results: The prevalence of nonaccidental elbow fractures across the 10-year study period was 0.4% (N=18). However, the prevalence of nonaccidental elbow fractures in those patients below 1 year of age was markedly higher at 30.3% (10/33). Among all elbow fractures in patients below 1 year of age, supracondylar humerus fractures were the most common fracture type (19/33, 57.6%), yet transphyseal fractures (6/33, 18.1%) were most commonly the result of NAT (5/6, 83.3%). In children over 1 year of age, fracture type was not an indicator of NAT. Conclusions: The vast majority of pediatric elbow fractures (99.6%) are accidental. However, certain factors, namely age below 1 year and transphyseal fractures increase the likelihood that these fractures may be a result of NAT. Level of Evidence: Level IV: retrospective case series.

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“…However, implementation of a standardized protocol has actually been shown to have no negative effect on hospital resource utilization, and, in fact, may actually reduce the need for hospitalization [48]. Finally, the implementation of a standard approach to the evaluation of NAT is supported by the Western Trauma Association, the Pediatric Trauma Society, and the American Pediatric Surgical Association [49,50].…”

Section: Standardized Nat Screeningmentioning

confidence: 99%

Non-accidental Trauma in Infants: a Review of Evidence-Based Strategies for Diagnosis, Management, and Prevention

et al. 2022

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Purpose of Review To provide a resource for providers that may be involved in the diagnosis and management of infant non-accidental trauma (NAT). Recent Findings Infants are more likely to both suffer from physical abuse and die from their subsequent injuries. There are missed opportunities among providers for recognizing sentinel injuries. Minority children are overrepresented in the reporting of child maltreatment, and there is systemic bias in the evaluation and treatment of minority victims of child abuse. Summary Unfortunately, no single, primary preventative intervention has been conclusively shown to reduce the incidence of child maltreatment. Standardized algorithms for NAT screening have been shown to increase the bias-free utilization of NAT evaluations. Every healthcare provider that interacts with children has a responsibility to recognize warning signs of NAT, be able to initiate the evaluation for suspected NAT, and understand their role as a mandatory reporter.

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Child physical abuse trauma evaluation and management: A Western Trauma Association and Pediatric Trauma Society critical decisions algorithm

Cited by 14 publications

References 41 publications

Association of Economic Recession and Social Distancing With Pediatric Non-accidental Trauma During COVID-19

Association of Economic Recession and Social Distancing With Pediatric Non-accidental Trauma During COVID-19

Nonaccidental Trauma in Pediatric Elbow Fractures: When You Should Be Worried

Non-accidental Trauma in Infants: a Review of Evidence-Based Strategies for Diagnosis, Management, and Prevention

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