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Craniofacial Injury Patterns and Predictors for Pediatric Non-Accidental Trauma.

Andrew Meci¹, Jessyka G Lighthall^1,2

¹The Pennsylvania State University College of Medicine, Hershey, PA.

The Journal of Craniofacial Surgery

|December 23, 2025

Summary

Non-accidental pediatric craniofacial trauma (NAT) is distinct from accidental trauma (AT), presenting with more soft tissue injuries and higher mortality. Early recognition of these patterns is crucial for timely intervention in child abuse cases.

Keywords:

Craniofacial trauma national trauma database non-accidental trauma pediatrics prediction modeling

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Area of Science:

Pediatric Trauma Surgery
Forensic Pediatrics
Craniofacial Surgery

Background:

Non-accidental pediatric craniofacial trauma (NAT) requires prompt recognition and treatment.
Limited comprehensive analyses contrast NAT with accidental trauma (AT).
This study identifies distinct injury patterns, demographics, and outcomes in pediatric facial trauma.

Purpose of the Study:

To identify distinct injury patterns in pediatric non-accidental craniofacial trauma (NAT).
To analyze demographic factors associated with NAT.
To compare outcomes between NAT and accidental trauma (AT) in pediatric patients.

Main Methods:

Retrospective analysis of the National Trauma Data Bank (2017-2019).
Identified pediatric patients (0-18 years) with facial injuries using ICD-10 codes for NAT.
Compared demographic characteristics, injury patterns, procedures, and mortality between NAT and AT groups.

Main Results:

NAT (1.1%) involved younger patients (3.0 vs 10.7 years) with higher injury severity.
NAT showed more soft tissue (56.3% vs 44.9%) and lateral facial injuries, fewer skeletal injuries.
NAT had substantially higher in-hospital mortality (9.5% vs 3.0%), with predictors including age 1-2 years, black race, and Hispanic ethnicity.

Conclusions:

Pediatric NAT exhibits distinct patterns: soft tissue injuries, lateral facial trauma, and associated traumatic brain injuries.
Findings aid in improving clinical recognition of potential child abuse.
Results inform the development of targeted screening protocols for NAT.