Related Experiment Video
Updated: Jul 9, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Children admitted to paediatric intensive care at Red Cross War Memorial Children's Hospital with non-accidental
L Bowes1, B Rossouw1, B M Morrow1
1Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
Insights
Children with severe non-accidental injuries (NAI) admitted to the paediatric intensive care unit (PICU) have high mortality rates and significant long-term disability. Early recognition and reporting of NAI are crucial for improving outcomes.
Area of Science:
- Pediatric Intensive Care
- Child Abuse and Neglect
- Public Health
Background:
- Violence against children is prevalent in South Africa.
- Severe non-accidental injuries (NAI) necessitate paediatric intensive care unit (PICU) admission.
- Outcomes for children with NAI in South African PICUs are not well-documented.
Purpose of the Study:
- To characterize patients admitted to the PICU with suspected NAI.
- To describe the outcomes of these critically ill children.
- To provide data on NAI in a South African PICU setting.
Main Methods:
- Retrospective descriptive study.
- Analysis of routinely collected data.
- Inclusion of all children admitted to PICU with suspected NAI from 2012-2020.
Main Results:
- 42 children (0.4% of PICU admissions) with suspected NAI were identified.
- The majority sustained physical injuries, primarily head trauma, often from assaults.
- PICU mortality was 28.6%, with 23.3% of survivors experiencing long-term disability.
Conclusions:
- Children with NAI represent a small but high-risk group in PICUs.
- High mortality and significant morbidity, including long-term disability, are associated with NAI.
- Emphasizes the need for early NAI recognition, reporting, and follow-up.
Background:
Violence against children remains common in South Africa (SA). Children sustaining severe non-accidental injuries (NAIs) may require admission to paediatric intensive care units (PICUs), however, their outcomes have not been well described in SA.
Objectives:
To describe the characteristics and outcomes of patients admitted to the PICU with suspected NAIs at Red Cross War Memorial Children's Hospital (RCWMCH).
Methods:
A retrospective descriptive study of routinely collected data from all children admitted to the PICU at RCWMCH with suspected NAIs from 1 January 2012 to 31 December 2020.
Results:
Of 11 345 children admitted to the PICU, 42 (0.4%) patients with suspected NAI (median (IQR) age 20.3 (7.9 - 62.6) months; 61.9% male) were included in data analysis. Most patients sustained physical injury (n=35; 83.3%) from assaults (n=19; 45.2%), and head injuries were the most common injury site, while 37 (88.1%) received invasive mechanical ventilation for a median (interquartile range) of 2.0 (1.0 - 3.8) days. PICU mortality was 28.6% (n=12), with a risk-adjusted mortality (observed/mean predicted mortality) of 3.6. Of the 30 PICU survivors, 7 (23.3%) were discharged with long-term disability, while the functional outcome of 16 (53.3%) survivors remains unknown.
Conclusion:
Children who have sustained NAI represent a small proportion of PICU admissions, with high mortality and considerable morbidity.
Contribution Of The Study:
Children with severe non-accidental injury (NAI) represent fewer than 0.5% of paediatric intensive care unit (PICU) admissions at Red Cross War Memorial Children's Hospital over a nine-year period. PICU mortality was 28.6%, more than double the general PICU mortality rate, with a risk adjusted mortality nearly four times the predicted rate. Head injury was the most common and most fatal injury pattern; most incidents occurred in the home, and the perpetrator was most often a family member. Nearly a quarter of survivors were discharged with long-term disability. These findings highlight the need for early clinical recognition of NAI, strict compliance with mandatory reporting obligations, and structured interdisciplinary follow-up of survivors.
