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A retrospective cohort study of suspected child maltreatment cases resulting in hospitalization
Lee S Friedman1, Shirley Sheppard, Daniel Friedman
1University of Illinois, School of Public Health, Division of Environmental and Occupational Health Sciences, Chicago, IL 60612, USA. lfriedman@tspri.org
Insights
Hospitalized children suffering abuse or neglect show distinct injury patterns. Child maltreatment significantly increases the risk of in-hospital death, highlighting the need for early recognition and intervention.
Area of Science:
- Pediatric Health
- Child Abuse and Neglect Research
- Public Health Surveillance
Background:
- Child abuse and neglect pose significant health risks, necessitating research into recognition and outcomes for hospitalized children.
- Existing studies highlight the need for larger investigations into the specific needs and mortality risks of children hospitalized due to maltreatment.
Purpose of the Study:
- To delineate injury and illness patterns in children hospitalized for abuse and neglect.
- To evaluate the association between child maltreatment and in-hospital mortality.
Main Methods:
- A retrospective cohort study analyzed medical records of 2656 children under 13 hospitalized for suspected maltreatment in Illinois (2000-2009).
- A matched comparison group of non-maltreated children was used for analysis.
- Data included injury types, illnesses, and patient disposition.
Main Results:
- Distinct injury, physical illness, and psychological disorder patterns were observed across maltreatment subgroups.
- Children with maltreatment had a nearly threefold increased odds of in-hospital death (adjusted OR=2.99).
- Discharge dispositions varied, with most returning home, some to protective services, and others to intermediate care.
Conclusions:
- Significant variations in diagnostic patterns and outcomes exist among hospitalized child maltreatment cases.
- This study reinforces findings from smaller studies, emphasizing the heightened mortality risk for abused and neglected children.
- The results underscore the critical need for improved identification and management strategies for child abuse and neglect.
Objectives:
Although the incidence and risk factors of child abuse have been well researched, there continues to be a need for large studies that provide information regarding the process of recognizing children whose health and lives are most seriously threatened by abuse and neglect, in particular children requiring hospitalization as a result of child abuse. The purpose of this study was to (1) describe differences in the type of injuries and illnesses of children hospitalized for abuse and neglect and (2) assess the relationship between in-hospital mortality and child maltreatment.
Methods:
For this retrospective cohort study, child maltreatment cases were identified using medical record databases of patients treated in all hospitals and trauma units in Illinois. A comparison group of children not suffering from suspected maltreatment were randomly selected and matched by age and data source to the suspected maltreatment cases.
Subjects:
2656 children under the age of 13 years suspected of suffering maltreatment who were admitted to any hospital in Illinois between 2000 and 2009.
Results:
The analysis showed distinct patterns in injury, physical illness and psychological disorders for each subgroup of maltreatment cases. Among the cases of maltreatment 75.6% were discharged home, 2.9% into child protective services and 15.8% to an intermediate care facility. In the final multivariable conditional logistic regression model, children suffering maltreatment continued to have a higher odds of dying during hospitalization (adjusted OR=2.99; CI95%: 1.63, 5.45; p<0.001).
Conclusion:
There were distinct diagnostic patterns and outcomes among suspected cases of child maltreatment admitted to Illinois hospitals over a 10-year period. This large retrospective cohort study confirms findings reported in many smaller studies and larger national cross-sectional surveys.
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