Understanding non-accidental trauma in the United States: A national trauma databank study.
Adolescent
Brain Injuries, Traumatic
/ epidemiology
Child
Child Abuse
/ statistics & numerical data
Child, Preschool
Critical Care
/ statistics & numerical data
Databases, Factual
Female
Hospitalization
/ statistics & numerical data
Humans
Incidence
Infant
Infant, Newborn
Injury Severity Score
Male
Multiple Trauma
/ epidemiology
Physical Abuse
/ statistics & numerical data
Retrospective Studies
Risk Factors
Trauma Centers
/ statistics & numerical data
United States
/ epidemiology
Young Adult
NAT
NTDB
Nonaccidental trauma
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
27
01
2019
revised:
07
03
2019
accepted:
28
03
2019
pubmed:
20
5
2019
medline:
2
10
2020
entrez:
20
5
2019
Statut:
ppublish
Résumé
The purpose of this study is to characterize the epidemiology, injury patterns, outcomes and trends of non-accidental trauma (NAT) in the United States using a large national database. Children <15 years presenting after NAT were identified in the 2007-2014 National Trauma Databank research datasets. Clinical and outcome data were analyzed using descriptive statistics, chi-square and logistic regression. Of 678,503 children admitted for traumatic injuries, 3% (19,149) were victims of NAT. The majority (95%) were under 5 years and 71% under 1 year old. The majority (59%) were male. The median injury severity score (ISS) was 10 (IQR:5-19). African Americans were disproportionally affected (27% vs 17% of all traumas), and the majority had public or no insurance (85%). Incidence was highest in the midwest and lowest in the northeast regions of the country, although trends varied over time. NAT resulted in 43% of trauma deaths in children <1 year and 31% of trauma deaths in children <5. Traumatic brain injury (TBI) was the most commonly encountered diagnosis (50%). Polytrauma was common, and certain injury patterns were identified. Urgent operation was required in 6%, 43% were admitted to intensive care, and 9% died. Mortality was independently associated with TBI, thoracic injury, hollow viscus injury and older age. Non-accidental trauma is a leading cause of trauma mortality in young children. Multiple injuries are common, requiring comprehensive evaluation and early surgical involvement. The data presented in this study could serve as a guide to target injury prevention efforts. III STUDY TYPE: Prognostic and Epidemiological.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this study is to characterize the epidemiology, injury patterns, outcomes and trends of non-accidental trauma (NAT) in the United States using a large national database.
METHODS
METHODS
Children <15 years presenting after NAT were identified in the 2007-2014 National Trauma Databank research datasets. Clinical and outcome data were analyzed using descriptive statistics, chi-square and logistic regression.
RESULTS
RESULTS
Of 678,503 children admitted for traumatic injuries, 3% (19,149) were victims of NAT. The majority (95%) were under 5 years and 71% under 1 year old. The majority (59%) were male. The median injury severity score (ISS) was 10 (IQR:5-19). African Americans were disproportionally affected (27% vs 17% of all traumas), and the majority had public or no insurance (85%). Incidence was highest in the midwest and lowest in the northeast regions of the country, although trends varied over time. NAT resulted in 43% of trauma deaths in children <1 year and 31% of trauma deaths in children <5. Traumatic brain injury (TBI) was the most commonly encountered diagnosis (50%). Polytrauma was common, and certain injury patterns were identified. Urgent operation was required in 6%, 43% were admitted to intensive care, and 9% died. Mortality was independently associated with TBI, thoracic injury, hollow viscus injury and older age.
CONCLUSION
CONCLUSIONS
Non-accidental trauma is a leading cause of trauma mortality in young children. Multiple injuries are common, requiring comprehensive evaluation and early surgical involvement. The data presented in this study could serve as a guide to target injury prevention efforts.
LEVEL OF EVIDENCE
METHODS
III STUDY TYPE: Prognostic and Epidemiological.
Identifiants
pubmed: 31103270
pii: S0022-3468(19)30335-5
doi: 10.1016/j.jpedsurg.2019.03.024
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
693-697Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.