The impact of regionality and hospital status on mortality associated with non-accidental trauma

Shah, Adil A.; Nizam, Wasay; Sandler, Anthony D.; Zuberi, Muhammad Maaz; Khan, Faraz A.; Manicone, Paul E.; Kane, Timothy D.; Petrosyan, Mikael

doi:10.1016/j.amjsurg.2021.06.014

Cited by 4 publications

(6 citation statements)

References 28 publications

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“…According to the NIS-4, the incidence of child maltreatment including abuse and neglect was 1.7% in 2005–2006 according to the more stringent and objective Harm standard but may be as high as 3.7% if the Endangerment standard is employed. Further, the incidence of child abuse among pediatric trauma patients has been previously reported to fall in a similar range of ∼2% to 8% 5,14. Although Black and Hispanic patients represent minority populations in the US, both were overrepresented in our study cohort.…”

Section: Discussionsupporting

confidence: 52%

“…Further, the incidence of child abuse among pediatric trauma patients has been previously reported to fall in a similar range of ∼2% to 8%. 5,14 Although Black and Hispanic patients represent minority populations in the US, both were overrepresented in our study cohort. This is in line with the literature demonstrating significant racial-ethnic, geographic, and socioeconomic differences in the incidence of child maltreatment, 13,14,16 but whether these differences are due to an empirically increased rate of child maltreatment in these populations, or due to them simply being screened and reported more often is unclear.…”

Section: Discussionmentioning

confidence: 91%

“…Of note, we also found that management at higher level ACS-verified pediatric trauma centers was associated with higher odds of initiation of abuse investigations and also higher odds for these investigations to result in a change of caregiver at discharge. Previous literature has demonstrated that management of child abuse at designated children’s hospitals results in the loss of racial and regional variation in mortality, with resultant diminished racial disparities in outcomes 14. This mitigation of variability in clinical outcomes of abuse seen at urban designated children’s hospitals was attributed to the growing regionalization of pediatric healthcare, and the direction of abuse victims with specific healthcare needs to well-equipped and specialized facilities that are optimized to manage such patients.…”

Section: Discussionmentioning

confidence: 99%

“…Previous literature has demonstrated that management of child abuse at designated children's hospitals results in the loss of racial and regional variation in mortality, with resultant diminished racial disparities in outcomes. 14 This mitigation of variability in clinical outcomes of abuse seen at urban designated children's hospitals was attributed to the growing regionalization of pediatric healthcare, and the direction of abuse victims with specific healthcare needs to well-equipped and specialized facilities that are optimized to manage such patients. However, this study did not assess the practices of interventions specific to abuse.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have demonstrated a lack of standardized screening and management protocols for the management of child abuse, 12 as well as significant racial-ethnic, regional, and socioeconomic disparities in outcomes of child abuse victims. 13,14 There is a paucity of data describing the nationwide management of child abuse, especially with regard to interventions specific to abuse. Such interventions may include investigations into the suspected abuse (entailing an exhaustive screening process, interviews with family, witnesses, and/or caregivers, and a risk/safety assessment), the results of which may help determine the need for a change of caregiver at discharge.…”

mentioning

confidence: 99%

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Nationwide Management of Trauma in Child Abuse

et al. 2022

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Objective: Child abuse is a major cause of childhood injury, morbidity, and death. There is a paucity of data on the practice of abuse interventions among this vulnerable population. The aim of our study was to identify the factors associated with interventions for child abuse on a national scale. Methods: Retrospective analysis of 2017 to 2018 American College of Surgeons (ACS) Pediatric Trauma Quality Improvement Program (TQIP). All children presenting with suspected/confirmed child abuse and an abuse report filed were included. Patients with missing information regarding abuse interventions were excluded. Outcomes were abuse investigations initiated among those with abuse reports, and change of caregiver at discharge among survivors with an investigation initiated. Multivariable regression analyses were performed. Results: A total of 7774 child abuse victims with an abuse report were identified. The mean age was 5±5 years, 4221 (54%) patients were White, 2297 (30%) Black, 1543 (20%) Hispanic, and 5298 (68%) had government insurance. The most common mechanism was blunt (63%), followed by burns (10%) and penetrating (10%). The median Injury Severity Score was 5 (1–12). The most common form of abuse was physical (92%), followed by neglect (6%), sexual (3%), and psychological (0.1%). The most common perpetrator of abuse was a care provider/teacher (49.5%), followed by a member of the immediate family (30.5%), or a member of the extended/step/foster family (20.0%). Overall, 6377 (82%) abuse investigations were initiated for those with abuse reports. Of these, 1967 (33%) resulted in a change of caregiver. Black children were more likely to have abuse investigated, and Black and Hispanic children were more likely to experience change of caregiver after investigations, while privately insured children were less likely to experience both. Conclusions: Significant racial, ethnic, and socioeconomic disparities exist in the nationwide management of child abuse. Further studies are strongly warranted to understand contributing factors and possible strategies to address them. Level of Evidence: Level III—therapeutic/care management.

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Section: Discussionsupporting

confidence: 52%