Adverse outcomes in child abuse: a 7-year analysis of patients with traumatic brain injury
Related Experiment Video
Updated: May 5, 2026
Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Insights
Child abuse-related traumatic brain injuries (TBIs) are linked to neighborhood disadvantage and more severe injuries. These children experience worse health outcomes, underscoring the need for targeted interventions and improved healthcare access.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Traumatology
Background:
- Child abuse is a significant public health concern impacting pediatric well-being.
- Traumatic brain injuries (TBIs) in child abuse cases present unique medical and social challenges.
Purpose of the Study:
- To investigate socioeconomic disparities in child abuse-related TBIs.
- To analyze injury characteristics and outcomes for pediatric TBI patients with a history of abuse.
Main Methods:
- Retrospective review of an institutional emergency department database (June 2016-June 2023).
- Identification of pediatric TBI cases (age ≤ 18) using ICD-10 codes and child abuse/neglect documentation.
- Analysis of demographics, zip codes, injury severity (ISS, TRISS), Social Deprivation Index (SDI), and clinical outcomes using regression models.
Main Results:
- The study analyzed 2954 TBI cases, with 13.4% identified as child abuse-related.
- Child abuse TBI patients were younger and more likely to arrive via private transport, reside in deprived neighborhoods (higher SDI), and sustain severe injuries (higher ISS, lower TRISS).
- Child abuse TBI cases showed higher odds of prolonged hospitalization, non-routine discharge, ICU transfer, and in-hospital death.
Conclusions:
- Child abuse-related TBI is associated with significant neighborhood disadvantage and increased injury severity.
- Adverse outcomes, including prolonged hospital stays and higher mortality, are more common in child abuse TBI cases.
- Targeted interventions are crucial to address socioeconomic disparities and enhance healthcare for this vulnerable pediatric population.
Objective:
Child abuse is a critical public health issue that profoundly affects pediatric health and well-being. Child abuse patients who have sustained traumatic brain injuries (TBIs) present with a unique subset of injuries with complex medical and social implications. This study aims to explore the socioeconomic disparities, injury characteristics, and outcomes in child abuse patients who have sustained TBIs.
Methods:
The authors conducted a retrospective review of their institutional emergency department (ED) database (June 2016-June 2023) to identify pediatric TBI cases (patient age ≤ 18 years) using ICD-10 codes based on a modified Centers for Disease Control and Prevention framework. Documented cases of child abuse, neglect, or inadequate supervision with investigations by a multidisciplinary child protection team were identified by reviewing the records of ED admissions. Patient demographics, zip codes, injury characteristics, and clinical outcomes were collected. The Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS), with higher ISSs and lower TRISSs indicating more severe injuries, respectively, were obtained. The Social Deprivation Index was used to assess neighborhood disadvantage, with higher scores indicating adverse health outcomes. Standard bivariate and multivariate regression analyses were performed.
Results:
This study included 2954 patients with TBI, whose mean age was 7.05 ± 5.50 years; 36.6% of the patients were female and 40.4% were White. Among the overall cohort of TBI cases, 86.6% were non-child abuse cases, while 13.4% were child abuse cases. The child abuse cohort had a significantly lower average age (2.02 vs 7.83 years, p < 0.001) than the non-child abuse group. In multivariate regression models, child abuse patients had higher odds of being conveyed to the hospital via private transport (adjusted odds ratio [aOR] 2.201, p < 0.001); had higher odds of residing in a deprived neighborhood, as indicated by the SDI (aOR 1.009, p < 0.001); and had sustained more severe injuries on admission, as indicated by the ISS and TRISS (aOR 1.064, p < 0.001; aOR 0.970, p < 0.001, respectively). Child abuse patients had higher odds of a prolonged hospital stay (aOR 4.061, p < 0.001), a nonroutine discharge (aOR 6.186, p < 0.001), ED transfer to the intensive care unit (aOR 2.696, p < 0.001), and death on admission (aOR 3.131, p < 0.001).
Conclusions:
This study highlights neighborhood disadvantage, more severe injuries, and adverse outcomes in child abuse-related TBI, emphasizing the need for targeted interventions to address socioeconomic disparities and improve healthcare for this vulnerable population.
