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Risk of Injury-Related Readmission Varies by Initial Presenting-Hospital Type Among Children at High Risk for
Christopher W Snyder1, Tara M Barry2, David J Ciesla2
1From the Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
Insights
Children with physical abuse indicators often present to community hospitals, increasing their risk of future severe injuries. Early evaluation at pediatric trauma centers is linked to better outcomes for these vulnerable children.
Area of Science:
- Pediatric medicine
- Trauma surgery
- Child abuse research
Background:
- Children experiencing physical abuse may present with subtle injuries initially.
- Delayed recognition of abuse can lead to severe, future harm.
Purpose of the Study:
- To identify young children with high-risk diagnoses for physical abuse.
- To characterize initial hospital presentations for these children.
- To assess the link between initial hospital type and subsequent injury admissions.
Main Methods:
- Analysis of Florida healthcare data (2009-2014) for children under 6 with high-risk abuse diagnoses.
- Categorization of initial hospitals: community, adult/combined trauma, or pediatric trauma centers.
- Multivariable logistic regression to evaluate associations with subsequent injury admissions within one year.
Main Results:
- 8626 high-risk children were included; 68% initially presented to community hospitals.
- 3% of children experienced subsequent injury admissions within a year.
- Initial presentation to community hospitals (OR 4.03) or adult/combined trauma centers (OR 3.19) increased risk of subsequent admissions compared to pediatric trauma centers.
Conclusions:
- Most high-risk children initially present to non-trauma centers.
- Pediatric trauma center evaluation is associated with reduced risk of subsequent injury.
- Enhanced collaboration between community hospitals and pediatric trauma centers is crucial for early identification and protection.
Objectives:
Children experiencing physical abuse may initially present to hospitals with underappreciated minor injuries, only to experience more severe injuries in the future. The objectives of this study were to 1) describe young children presenting with high-risk diagnoses for physical abuse, 2) characterize the hospitals to which they initially presented, and 3) evaluate associations of initial presenting-hospital type with subsequent admission for injury.
Methods:
Patients aged younger than 6 years from the 2009-2014 Florida Agency for Healthcare Administration database with high-risk diagnoses (codes previously associated with >70% risk of child physical abuse) were included. Patients were categorized by the hospital type to which they initially presented: community hospital, adult/combined trauma center, or pediatric trauma center. Primary outcome was subsequent injury-related hospital admission within 1 year. Association of initial presenting-hospital type with outcome was evaluated with multivariable logistic regression, adjusting for demographics, socioeconomic status, preexisting comorbidities, and injury severity.
Results:
A total of 8626 high-risk children met inclusion criteria. Sixty-eight percent of high-risk children initially presented to community hospitals. At 1 year, 3% of high-risk children had experienced subsequent injury-related admission. On multivariable analysis, initial presentation to a community hospital was associated with higher risk of subsequent injury-related admission (odds ratio, 4.03 vs level 1/pediatric trauma center; 95% confidence interval, 1.83-8.86). Initial presentation to a level 2 adult or combined adult/pediatric trauma center was also associated with higher risk for subsequent injury-related admission (odds ratio, 3.19; 95% confidence interval, 1.40-7.27).
Conclusions:
Most children at high risk for physical abuse initially present to community hospitals, not dedicated trauma centers. Children initially evaluated in high-level pediatric trauma centers had lower risk of subsequent injury-related admission. This unexplained variability suggests stronger collaboration is needed between community hospitals and regional pediatric trauma centers at the time of initial presentation to recognize and protect vulnerable children.
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