National Risk Factors for Child Maltreatment after Trauma: Failure to Prevent

Area of Science:

• Pediatrics
• Public Health
• Trauma Care

Background:

• Child maltreatment is a significant public health issue.
• Accurate identification of child maltreatment in trauma admissions is essential for timely intervention and prevention of recurrent abuse.

Purpose of the Study:

• To identify risk factors for hospital readmission due to child maltreatment after initial trauma admission.
• To investigate factors associated with readmission to a different hospital for maltreatment.
• To analyze risk factors for maltreatment readmission missed during the initial trauma admission.

Main Methods:

• Utilized the Nationwide Readmissions Database (2010-2014) for pediatric trauma admissions (<18 years).
• Employed multivariable logistic regression to determine risk factors for primary (maltreatment readmission) and secondary (readmission to a different hospital) outcomes.
• Conducted a subgroup analysis for cases where maltreatment was not identified during the index admission.

Main Results:

• Of 608,744 trauma admissions, 7.32% involved maltreatment. Readmission for maltreatment occurred in 0.32% of patients.
• Maltreatment identified during the index admission significantly increased readmission risk (OR 9.48).
• Lowest median household income quartile was a strong risk factor for readmission to a different hospital (OR 3.50).
• Severe injury (Injury Severity Score > 15) was linked to missed maltreatment diagnoses and subsequent readmission (OR 3.29).

Conclusions:

• A substantial number of pediatric trauma admissions may be misclassified, masking underlying child maltreatment.
• Index trauma admissions represent a critical opportunity for maltreatment intervention.
• Targeted identification of high-risk children is vital for effective child maltreatment prevention strategies.