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Evaluating Outcomes of Nonaccidental Trauma in Military Children
Katie Joskowitz1, Utsav M Patwardhan1,2, Gretchen M Floan2
1From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio).
Insights
Military children experiencing nonaccidental trauma (child abuse) face worse outcomes, including longer hospital stays and higher mortality rates, compared to civilian children. This highlights a critical need for targeted support for military families.
Area of Science:
- Pediatrics
- Trauma Surgery
- Military Health
Background:
- Nonaccidental trauma (NAT), or child abuse, is a significant cause of pediatric injury and mortality in the U.S.
- Military-affiliated families may face increased risks for domestic violence and child maltreatment.
- Limited data exists on the outcomes of military children who have experienced NAT.
Purpose of the Study:
- To compare the outcomes of military-dependent children diagnosed with NAT versus civilian children with NAT.
- To identify specific disparities in care and outcomes for military children subjected to abuse.
Main Methods:
- Retrospective review of children admitted with confirmed NAT at a Level I trauma center.
- Data collected from institutional trauma registry and Child Abuse Team database.
- Military affiliation identified via insurance and self-reported active-duty status; clinical data compared.
Main Results:
- Military-affiliated children (11.8%) were younger (median 3 months) and experienced longer hospital stays (4 days vs. 2 days).
- Military-affiliated patients had increased morbidity (3 vs. 2 counts) and a higher mortality rate (10% vs. 4%).
- No significant differences were found in consults, injuries, trauma activation, or need for surgery.
Conclusions:
- Military-affiliated children with NAT exhibit more severe outcomes, including increased length of stay, morbidity, and mortality.
- These findings suggest military children may experience more life-threatening NAT at a younger age.
- Further research is needed to understand and support this vulnerable population.
Background:
Nonaccidental trauma (NAT), or child abuse, is a leading cause of childhood injury and death in the US. Studies demonstrate that military-affiliated individuals are at greater risk of mental health complication and family violence, including child maltreatment. There is limited information about the outcomes of military children who experience NAT. This study compares the outcomes between military-dependent and civilian children diagnosed with NAT.
Study Design:
A single-institution, retrospective review of children admitted with confirmed NAT at a Level I trauma center was performed. Data were collected from the institutional trauma registry and the Child Abuse Team's database. Military affiliation was identified using insurance status and parental or caregiver self-reported active-duty status. Demographic and clinical data including hospital length of stay (LOS), morbidity, specialty consult, and mortality were compared.
Results:
Among 535 patients, 11.8% (n = 63) were military-affiliated. The median age of military-associated patients, 3 months (interquartile range [IQR] 1 to 7), was significantly younger than civilian patients, 7 months (IQR 3 to 18, p < 0.001). Military-affilif:ated patients had a longer LOS of 4 days (IQR 2 to 11) vs 2 days (IQR 1 to 7, p = 0.041), increased morbidity or complication (3 vs 2 counts, p = 0.002), and a higher mortality rate (10% vs 4%, p = 0.048). No significant difference was observed in the number of consults or injuries, trauma activation, or need for surgery.
Conclusions:
Military-affiliated children diagnosed with NAT experience more adverse outcomes than civilian patients. Increased LOS, morbidity or complication, and mortality suggest military-affiliated patients experience more life-threatening NAT at a younger age. Larger studies are required to further examine this population and better support at-risk families.
