Characteristics Among a Pediatric Cohort Arriving Via EMS Following Nonaccidental and Accidental Trauma

To describe the characteristics of injured children arriving at a Pediatric Level I Trauma Center via Emergency Medical Services (EMS) and determine predictive characteristics for children injured due to nonaccidental trauma (NAT).

A single-center retrospective cohort study was performed for children 5 years of age and younger arriving via EMS from January 2016 through December 2018. NAT finding was made by a Multidisciplinary Child Protection Team of child abuse clinicians, representatives from Child Protective Services, law enforcement, and District Attorney's offices. The rate of NAT was determined, and prehospital (ie, demographics) and hospital (ie, highest level of care) factor differences were explored between children with injuries sustained from NAT versus accidental trauma (AT). Additional subanalyses examined those among the cohort with head injuries.

The sample included 352 children; 8.5% were found with injuries sustained from NAT. These children were younger, needed higher levels of care (ie, admission) and more likely to have EMS scene times >15 minutes (aOR 3.46) compared with those with AT. Among the population with head injuries (n=121), 9% were sustained from NAT. Like the full cohort, children were younger and more likely to have EMS scene times >15 minutes.

In our study, a substantial proportion of injured children arriving at the hospital via EMS were victims of NAT. These children were younger and had injuries warranting higher levels of care than those with AT. Significantly higher EMS scene times among the NAT group warrant more exploration.