Child abuse and unintentional injuries - A 10-year retrospective

Objective: To identify differences between hospitalized children injured by child abuse and those with unintentional injuries. Design: Comparative analysis of patients injured by child abuse (n = 1997) with patients injured unintentionally (n = 16 831), newborn to 4 years of a ge. Main Outcome Measures: Patient characteristics, nature and severity of inju ry, treatment, length of stay, survival, functional limitations, and dispos ition at discharge from the hospital. Data Source: Retrospective review of medical records submitted to the Natio nal Pediatric Trauma Registry between January 1, 1988, and December 31, 199 7. Results: During the 10-year study period, child abuse accounted for 10.6% o f all blunt trauma to patients younger than 5 years. Children injured by ch ild abuse were significantly younger (mean, 12.8 vs 25.5 months) and were m ore likely to have preinjury medical history (53%; vs 14.1%) and retinal he morrhages (27.8% vs 0.06%) than children with unintentional injuries. Abuse d children were mainly injured by battering (53%) and by shaking (10.3%); u nintentionally injured children were hurt mainly by falls (58.4%) and by mo tor vehicle-related events (37.1%). Abused children were more likely than u nintentionally injured children to sustain intracranial injury (42.2% vs 14 .1%) and thoracic (12.5% vs 4.5%) and abdominal (11.4% vs 6.8%) injuries; t o sustain very severe injuries (22.6% vs 6.3%); to be admitted to the inten sive care unit (42.5% vs 26.9%); and to receive Child Protective Services ( 82.3% vs 8%) and Social Services (72.9% vs 27.6%) intervention. The mean le ngth of stay for children who were abused was significantly longer (9.3 vs 3.8 days) and the survival to discharge from the hospital was significantly worse (87.3% vs 97.4%) than for chose unintentionally injured. Among the s urvivors, children who were abused developed extensive functional limitatio ns more frequently than those unintentionally injured (8.7% us 2.7%). More than half (56.6%) of the children who were abused were discharged to custod ial/foster/Child Protective Services care; most (96.1%) of the children uni ntentionally injured returned to their homes. Conclusions: Child abuse continues to be a serious cause of mortality and m orbidity to infants and toddlers. On average, among children hospitalized f or blunt trauma, those injured by abuse sustain more severe injuries, use m ore medical services, and have worse survival and functional outcome than c hildren with unintentional injuries.