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National burden of pediatric abusive injuries: patterns vary by age
Carlos Theodore Huerta1, Eduardo A Perez2, Hallie Quiroz2
1DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA. cth62@med.miami.edu.
Insights
Child abuse hospitalization data reveals physical abuse is most common, but emotional abuse and neglect rise in adolescents. Intrathoracic injuries and abusive head trauma (AHT) correlate with high mortality rates.
Area of Science:
- Pediatric Medicine
- Public Health
- Forensic Medicine
Background:
- Child abuse is a significant public health concern.
- Healthcare practitioners often fail to recognize child abuse.
- Understanding injury patterns and mortality is crucial for intervention.
Purpose of the Study:
- To characterize pediatric abuse injury patterns nationwide.
- To determine mortality rates associated with different types of child abuse.
- To identify demographic factors influencing abuse and injury types.
Main Methods:
- Utilized the Kids' Inpatient Database (1997-2012).
- Included patients under 18 diagnosed with child abuse (physical, sexual, emotional, neglect, abusive head trauma [AHT]).
- Compared demographic factors, mortality, and injury patterns using statistical tests.
Main Results:
- Over 39,000 children hospitalized for abuse; 70% were under 4 years old.
- Physical abuse was most common (53%), followed by AHT (14%).
- Mortality was 4%; burns and intrathoracic injuries had the highest mortality rates (21% and 19%).
Conclusions:
- Adolescents (13-18 years) hospitalized for abuse are more likely to experience emotional abuse and neglect.
- Abusive head trauma (AHT) and intrathoracic injuries are linked to significant mortality.
- Findings highlight the need for improved recognition and tailored interventions for different age groups.
Purpose:
Child abuse is often unrecognized by healthcare practitioners. This study sought to characterize pediatric abuse injury patterns and associated mortality rates in a nationwide cohort.
Methods:
The Kids' Inpatient Database (1997-2012) was queried for patients < 18 years old with a diagnosis of child abuse (utilizing ICD-9 codes for abusive head trauma [AHT], neglect, physical, emotional, sexual, and other abuse). Demographic factors, mortality, and injury patterns were compared with demographic factors using standard statistical tests.
Results:
> 39,000 children were hospitalized for abuse from 1997 to 2012. The majority were Caucasian (36%), male (51%) and < 4 years old (70%). Most sustained physical abuse (53%), followed by AHT (14%), sexual (9%) and emotional abuse (2%). Multiple injuries were sustained by 44% of patients. Mortality was 4% (n = 1476). Burns (2%) and intrathoracic (2%) injuries had the highest mortality compared to other injuries (21% and 19%, respectively; both P < 0.001). Emotional abuse (5%) and neglect (1%) were highest in those ≥ 13 years old (both P = 0.001).
Conclusion:
Physical injuries are less common in adolescents (13-18 years) hospitalized for abuse. However, they are more likely to report emotional abuse and neglect, which has not been compared in previous studies. Intrathoracic injuries and AHT are associated with significant mortality.
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