Craniofacial Injury Patterns and Predictors for Pediatric Non-Accidental Trauma

Non-accidental pediatric craniofacial trauma (NAT) requires prompt recognition and treatment to ensure optimal patient outcomes and prevent recurrence. However, there are limited comprehensive analyses contrasting pediatric non-accidental to accidental trauma (AT). This study aimed to identify distinct injury patterns, demographic factors, and outcomes that characterize NAT in the pediatric facial trauma population.

We conducted a retrospective analysis of the National Trauma Data Bank from 2017 to 2019, identifying pediatric patients (0-18 years) with facial injuries. NAT cases were identified using specific ICD-10 codes. Demographic characteristics, injury patterns, procedure utilization, and mortality were compared between NAT and AT groups. Multivariate logistic regression models were constructed to identify independent predictors of NAT, with age-stratified analyses performed to examine age-specific patterns.

Among 166,547 pediatric facial trauma patients, 1742 (1.1%) were classified as NAT. NAT patients were younger (mean 3.0 versus 10.7 years), had higher injury severity scores (11.7 versus 9.0), and exhibited more soft tissue injuries (56.3% versus 44.9%) but fewer skeletal injuries (13.8% versus 19.8%). Lateral facial injuries and abdominal trauma were significantly associated with NAT. Age 1 to 2 years, black race, and Hispanic ethnicity were independent predictors. In-hospital mortality was substantially higher in NAT patients (9.5% versus 3.0%), particularly in younger children.

NAT cases in pediatric facial trauma present with distinct injury patterns, particularly soft tissue injuries, lateral facial involvement, and associated traumatic brain injuries. These findings can improve clinical recognition of potential abuse and inform the development of targeted screening protocols.