Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center

Area of Science:

• Pediatric Trauma
• Child Abuse Forensics
• Public Health

Background:

• Pediatric nonaccidental trauma (NAT) presents diagnostic challenges, as injuries can mimic accidental trauma (AT).
• A high index of suspicion is critical for identifying abuse and preventing mortality.
• Level 1 Pediatric Trauma Centers (PTCs) manage a significant number of NAT cases.

Purpose of the Study:

• To evaluate the specific injury patterns of NAT admissions in young children.
• To analyze demographic data, mortality, and disposition of NAT cases.
• To identify correlations between injury patterns and patient disposition.

Main Methods:

• Retrospective analysis of children under two years old admitted with NAT between 2016-2018.
• Data collection included demographics, injury types, mortality, and disposition.
• Statistical analysis used Fisher Exact test and student t-test for significance.

Main Results:

• 35% of trauma admissions in children under two were diagnosed as NAT.
• Facial, torso, lower extremity, retinal, and internal organ injuries were more prevalent in NAT.
• 97% of NAT patients had Medicaid, and 62.5% were legally displaced.

Conclusions:

• One-third of pediatric trauma admissions were NAT, highlighting the need for vigilance.
• Variable injury patterns necessitate a high index of suspicion for accurate NAT diagnosis.
• Nearly one-third of NAT victims returned to their abusive environment, increasing re-injury risk.