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Ezeokoli EU, Pang LK, Loyd NG, Borici N, Bachim A, Vogel AM, Rosenfeld SB. Child traumatic physical abuse rates and comparisons during the COVID-19 pandemic: Retrospective paediatric single institution review in Texas. J Paediatr Child Health 2023; 59:1129-1134. [PMID: 37455617 DOI: 10.1111/jpc.16468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
AIM The COVID-19 pandemic drastically altered human behaviour and socialisation and may have created an environment that could lead to increased incidence of domestic abuse and non-accidental trauma, or child physical abuse (CPA). Initial reports about the effect of the COVID-19 pandemic on the rates of CPA have been mixed. The purpose of this study is to describe the effects of COVID-19 on rates of CPA in a large metropolitan paediatric hospital and level I paediatric trauma centre. METHODS We identified and compared all CPA admissions under 18 years from May 2019 to February 2020 and considered that to be the pre-COVID time frame. The ensuing 12-month period of March 2020 to February 2021 was considered to be the intra-COVID time frame. RESULTS There were 49 (0.32%) unique CPA patients pre-COVID and 83 (0.85%) unique CPA patients intra-COVID (P < 0.001) with lower total admissions for any reason during the intra-COVID time frame. Monthly CPA cases were increased (P < 0.03) during the intra-COVID time period (mean 6.9, 95% confidence interval: 5.8-12.7) compared to the pre-COVID time period (mean 4.9, 95% confidence interval: 3.3-8.2). CONCLUSION During the COVID-19 pandemic, there were decreased overall hospital admissions in the period of mandated shutdowns and isolation. However, we saw an increased rate of CPA admissions compared to the time period prior to the pandemic. Knowledge of such data, trends and circumstances will help keep health-care providers alert and vigilant in identifying children at risk for maltreatment, and may impact child abuse protocols and guidelines.
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Affiliation(s)
- Ekene U Ezeokoli
- Division of Pediatric Orthopedic Surgery, Texas Children's Hospital, Houston, Texas, United States
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
| | - Lon Kai Pang
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
| | - Nathaniel G Loyd
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
| | - Neritan Borici
- Division of Pediatric Orthopedic Surgery, Texas Children's Hospital, Houston, Texas, United States
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
| | - Angela Bachim
- Department of Pediatrics, Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States
| | - Adam M Vogel
- Division of Pediatric Surgery, Department of Surgery Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, United States
| | - Scott B Rosenfeld
- Division of Pediatric Orthopedic Surgery, Texas Children's Hospital, Houston, Texas, United States
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
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Hong PKW, Santana JP, Larson SD, Berger A, Mustafa MM, Taylor JA, Islam S, Neal D, Petroze RT. Structural evaluation of child physical abuse in trauma: Social determinants of health at the population level. J Pediatr Surg 2023; 58:106-10. [PMID: 36335011 DOI: 10.1016/j.jpedsurg.2022.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Child physical abuse (CPA) is closely linked to social factors like insurance status with limited evaluation at a structural population-level. This study evaluates the role of social determinants of health within the built environment on CPA. METHODS A single-institution retrospective review of pediatric trauma patients was conducted between January 2016 and December 2020. Patient address was geocoded to the census-tract level. Socioeconomic metrics, including poverty rate, supermarket access and Social Vulnerability Index (SVI) were estimated from the Food Access Research Atlas. Univariate and multivariable regression analyses were conducted to compare demographics and outcomes. RESULTS Of 3,540 patients, 317 (9.0%) had concern for physical abuse reported in the registry. CPA patients were younger (7.5 vs 9.6 years, p<0.0001) and more often Black (37.0%, N = 117 vs 23.5%, N = 753; p<0.0001). CPA had higher injury severity scores (ISS) (7.9 vs 5.8, p<0.0001) and longer length of stay (5.3 vs 2.9 days, p<0.0001). CPA had higher Medicaid (73.0%, N = 232 vs 53.8%, N = 1748, p<0.0001) and SVI (0.65 vs 0.59, p<0.0001) with lower median income ($52,100 vs $56,100, p<0.0001) and more low-food access tracts (59.6% vs 53.6%, p = 0.06). Combined low-income and low-food access populations showed widened disparities (40.0% vs 28.9%, p = 0.0002). On multivariate analysis, CPA was associated with poverty (OR 2.3, 95% CI [0.979, 3.60], p = 0.0006), low-access Black share (OR 3.3, 95% CI [1.18, 5.47], p = 0.002) and urban designation (OR 1.5, 95% CI [1.13, 1.87], p = 0.004). CONCLUSION The built-environment and population-level social determinants of health are related to child physical abuse and should influence advocacy and prevention. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective.
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Theodorou CM, Brown EG, Jackson JE, Beres AL. Child Abuse and the COVID-19 Pandemic. J Surg Res 2022; 276:18-23. [PMID: 35325681 DOI: 10.1016/j.jss.2022.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has widespread effects, including enhanced psychosocial stressors and stay-at-home orders which may be associated with higher rates of child abuse. We aimed to evaluate rates of child abuse, neglect, and inadequate supervision during the COVID-19 pandemic. METHODS Patients ≤5 y old admitted to a level one pediatric trauma center between 3/19/20-9/19/20 (COVID-era) were compared to a pre-COVID cohort (3/19/19-9/19/19). The primary outcome was the rate of child abuse, neglect, or inadequate supervision, determined by Child Protection Team and Social Work consultations. Secondary outcomes included injury severity score (ISS), mortality, and discharge disposition. RESULTS Of 163 total COVID-era pediatric trauma patients, 22 (13.5%) sustained child abuse/neglect, compared to 17 of 206 (8.3%) pre-COVID era patients (P = 0.13). The ISS was similar between cohorts (median 9 pre-COVID versus 5 COVID-era, P = 0.23). There was one mortality in the pre-COVID era and none during COVID (P = 0.45). The rate of discharge with someone other than the primary caregiver at time of injury was significantly higher pre-COVID (94.1% versus 59.1%, P = 0.02). In addition, foster family placement rate was twice as high pre-COVID (50.0% versus 22.7%, P = 0.10). CONCLUSIONS The rate of abuse/neglect among young pediatric trauma patients during COVID did not differ compared to pre-pandemic, but discharge to a new caregiver was significantly lower. While likely multifactorial, this data suggests that resources during COVID may have been limited and the clinical significance of this is concerning. Larger studies are warranted to further evaluate COVID-19's effect on this vulnerable population.
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Huerta CT, Perez EA, Quiroz H, Quinn K, Thorson CM, Hogan AR, Brady AC, Sola JE. National burden of pediatric abusive injuries: patterns vary by age. Pediatr Surg Int 2022; 38:513-520. [PMID: 34999935 DOI: 10.1007/s00383-022-05062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Child abuse is often unrecognized by healthcare practitioners. This study sought to characterize pediatric abuse injury patterns and associated mortality rates in a nationwide cohort. METHODS The Kids' Inpatient Database (1997-2012) was queried for patients < 18 years old with a diagnosis of child abuse (utilizing ICD-9 codes for abusive head trauma [AHT], neglect, physical, emotional, sexual, and other abuse). Demographic factors, mortality, and injury patterns were compared with demographic factors using standard statistical tests. RESULTS > 39,000 children were hospitalized for abuse from 1997 to 2012. The majority were Caucasian (36%), male (51%) and < 4 years old (70%). Most sustained physical abuse (53%), followed by AHT (14%), sexual (9%) and emotional abuse (2%). Multiple injuries were sustained by 44% of patients. Mortality was 4% (n = 1476). Burns (2%) and intrathoracic (2%) injuries had the highest mortality compared to other injuries (21% and 19%, respectively; both P < 0.001). Emotional abuse (5%) and neglect (1%) were highest in those ≥ 13 years old (both P = 0.001). CONCLUSION Physical injuries are less common in adolescents (13-18 years) hospitalized for abuse. However, they are more likely to report emotional abuse and neglect, which has not been compared in previous studies. Intrathoracic injuries and AHT are associated with significant mortality.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA.
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA
| | - Hallie Quiroz
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA
| | - Kirby Quinn
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA
| | - Anthony R Hogan
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA
| | - Ann-Christina Brady
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA
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Salokorpi N, Sinikumpu JJ, Serlo W. Abusive head trauma in small children - a single-centre experience in Finland. Childs Nerv Syst 2022; 38:2371-2374. [PMID: 36287258 PMCID: PMC9908619 DOI: 10.1007/s00381-022-05715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022]
Abstract
Shaken baby syndrome (SBS) is a challenging condition from both a medical and legal perspective. The path of the patients differs significantly from those with noninflicted traumas. While treating these cases, it is essential that all history, information and treatment are comprehensively documented. This article describes the investigations and interventions necessary as soon as SBS is suspected. The Oulu University Hospital protocol for suspected child abuse is described. Authors also give an overview of the SBS path in Finland from the police and prosecution's point of view.
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Affiliation(s)
- Niina Salokorpi
- Department of Neurosurgery, Neurocenter, Oulu University Hospital, Oulu, Finland.
- Research Unit of Clinical Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Juha-Jaakko Sinikumpu
- Unit of Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Willy Serlo
- Unit of Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland
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Abstract
Child family violence homicide (FVH) is a significant public health problem in Australia and globally. Population-wide studies of orofacial injuries in child FVH are uncommon despite their recognized importance. This whole population descriptive study of orofacial injuries in child FVH in Victoria, Australia aims to implement a novel methodological approach to provide an overview of child FVH and describe frequency and patterns of abusive orofacial injuries. Closed cases of child FVH aged 0-17 years, January 2000-December 2018, were identified from screening all Victorian assault deaths for eligible offender relationships. Significant associations of clinical/demographic characteristics were explored using two-step clustering and the Spearman correlation coefficient. Of 895 closed homicide cases, 358 were FV-related. Of the 53 child FVH, 40 were eligible for injury analysis with 36 of these cases (90%) having orofacial injuries. Among these 36 cases, 72% were aged 0-4 years, males predominated (64%) and the injury mechanism was blunt force for 56%. The discrete orofacial injury frequency was associated with the non-orofacial injury frequency (rho: 0.362, 2-tailed p < 0.03). A three-cluster statistical solution was identified, each represented by an injury mechanism. The largest cluster identified a pattern of blunt force trauma in 0-4 years with drug presence, high average non-orofacial injury numbers and parent-offenders. A novel methodological approach was implemented to comprehensively describe the frequency, nature, patterns and risk indicators of orofacial injuries in child FVH. It explored associations between a wide range of clinical and demographic characteristics, which might have otherwise been missed in summary description. These methods will potentially underpin future comparative studies of intentional-unintentional child injuries and fatal-nonfatal child abuse. The study narrows a significant research gap regarding patterns of inflicted injuries, and demographic and clinical indicators in child FVH potentially informing future systematic classification processes, risk assessment tools and pathways to FV intervention.
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Affiliation(s)
- Reena Sarkar
- Department of Forensic Medicine, Monash University, Victoria, 3006, Australia.
| | - Richard Bassed
- Department of Forensic Medicine, Monash University, Victoria, 3006, Australia
- Victorian Institute of Forensic Medicine, Victoria, 3006, Australia
| | - Joanna F Dipnall
- Pre-Hospital, Emergency and Trauma Research, School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
- School of Medicine, Deakin University, Victoria, 3216, Australia
| | - Joan Ozanne-Smith
- Department of Forensic Medicine, Monash University, Victoria, 3006, Australia
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Maitz A, Haussner F, Braumüller S, Hoffmann A, Lupu L, Wachter U, Radermacher P, Braun CK, Wilke HJ, Vogt M, Ignatius A, Halbgebauer R, Bettac L, Barth TFE, Huber-Lang M, Palmer A. Temporal-spatial organ response after blast-induced experimental blunt abdominal trauma. FASEB J 2021; 35:e22038. [PMID: 34748229 DOI: 10.1096/fj.202100995r] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/14/2021] [Accepted: 10/28/2021] [Indexed: 11/11/2022]
Abstract
Abdominal trauma (AT) is of major global importance, particularly with the increased potential for civil, terroristic, and military trauma. The injury pattern and systemic consequences of blunt abdominal injuries are highly variable and frequently underestimated or even missed, and the pathomechanisms remain still poorly understood. Therefore, we investigated the temporal-spatial organ and immune response after a standardized blast-induced blunt AT. Anesthetized mice were exposed to a single blast wave centered on the epigastrium. At 2, 6, or 24 h after trauma, abdominal organ damage was assessed macroscopically, microscopically, and biochemically. A higher degree of trauma severity, determined by a reduction of the distance between the epigastrium and blast inductor, was reflected by a reduced survival rate. The hemodynamic monitoring during the first 120 min after AT revealed a decline in the mean arterial pressure within the first 80 min, whereas the heart rate remained quite stable. AT induced a systemic damage and inflammatory response, evidenced by elevated HMGB-1 and IL-6 plasma levels. The macroscopic injury pattern of the abdominal organs (while complex) was consistent, with the following frequency: liver > pancreas > spleen > left kidney > intestine > right kidney > others > lungs and was reflected by microscopic liver and pancreas damages. Plasma levels of organ dysfunction markers increased during the first 6 h after AT and subsequently declined, indicating an early, temporal impairment of the function on a multi-organ level. The established highly reproducible murine blunt AT, with time- and trauma-severity-dependent organ injury patterns, systemic inflammatory response, and impairment of various organ functions, reflects characteristics of human AT. In the future, this model may help to study the complex immuno-pathophysiological consequences and innovative therapeutic approaches after blunt AT.
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Affiliation(s)
- Alexander Maitz
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany
| | - Felix Haussner
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany
| | - Sonja Braumüller
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany
| | - Andrea Hoffmann
- Institute of Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
| | - Ludmila Lupu
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany
| | - Ulrich Wachter
- Institute of Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
| | - Peter Radermacher
- Institute of Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany
| | - Christian K Braun
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany.,Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Morten Vogt
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Rebecca Halbgebauer
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany
| | - Lucas Bettac
- Department of Internal Medicine I, Ulm University Medical Center, Ulm, Germany
| | - Thomas F E Barth
- Institute of Pathology, Ulm University Medical Center, Ulm, Germany
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany
| | - Annette Palmer
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany
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Lewis SL, Liebe H, Jeffery C, Sebastian R, Stewart KE, Sarwar Z, Gamino L, Johnson JJ. Traumatic Pediatric Fatalities: Are They Preventable? J Surg Res 2021; 269:158-164. [PMID: 34563842 DOI: 10.1016/j.jss.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Trauma related injury remains the leading cause of mortality in pediatric patients, many of which are preventable. The goal of our study was to identify the mechanism of injury (MOI) in pediatric trauma-related fatalities and determine if these injuries were preventable to direct future injury prevention efforts within trauma programs. METHODS After IRB approval, a retrospective, single-institution review of pediatric (age ≤18) trauma fatalities from 2010 to 2019 was performed. MOI, use of protective devices, demographics, and whether the injury was preventable were collected. Patients were divided into five age cohorts, and frequencies and proportions were used to summarize data. Bivariate testing was done using Fisher's exact and Monte Carlo estimates for the exact test. RESULTS MOI was found to vary by age with non-accidental trauma found to be the most common cause of trauma related deaths in children <1 (88.5%) and 1-4 (33.3%). MVC was the most common MOI in children >5 y, with 68.4% in the 5-9, 34.4% in the 10-14, and 45.8% in the 15-18 age group. The majority of fatalities resulted from a preventable injury (P < 0.0001) in the younger children with a negative association as age increased: 92.3% <1, 53.3% in 1-4, 36.8% in 5-9, 46.9% in 10-14 and 48.6% in 15-18. Of the preventable injuries, non-accidental trauma was the most common MOI in children <5, while GSW was the most common MOI in children >10. CONCLUSIONS This study demonstrates many pediatric fatalities are the result of a preventable traumatic injury. This data can guide focused traumatic injury prevention efforts.
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Affiliation(s)
- Samara L Lewis
- The University of Oklahoma Health Sciences Center, Department of Surgery, Oklahoma City, Oklahoma.
| | - Heather Liebe
- Oklahoma Children's Hospital at OU Health, Department of Pediatric Surgery, Oklahoma City, Oklahoma
| | - Christopher Jeffery
- The University of Oklahoma Health Sciences Center, Department of Surgery, Oklahoma City, Oklahoma
| | - Rohan Sebastian
- The University of Oklahoma Health Sciences Center, Department of Surgery, Oklahoma City, Oklahoma
| | - Kenneth E Stewart
- The University of Oklahoma Health Sciences Center, Department of Surgery, Oklahoma City, Oklahoma
| | - Zoona Sarwar
- The University of Oklahoma Health Sciences Center, Department of Surgery, Oklahoma City, Oklahoma
| | - Laura Gamino
- Oklahoma Children's Hospital at OU Health, Department of Pediatric Surgery, Oklahoma City, Oklahoma
| | - Jeremy J Johnson
- Oklahoma Children's Hospital at OU Health, Department of Pediatric Surgery, Oklahoma City, Oklahoma
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Kovler ML, Ziegfeld S, Ryan LM, Goldstein MA, Gardner R, Garcia AV, Nasr IW. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. Child Abuse Negl 2021; 116:104756. [PMID: 33004213 PMCID: PMC7518108 DOI: 10.1016/j.chiabu.2020.104756] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The Covid-19 pandemic has forced mass closures of childcare facilities and schools. While these measures are necessary to slow virus transmission, little is known regarding the secondary health consequences of social distancing. The purpose of this study is to assess the proportion of injuries secondary to physical child abuse (PCA) at a level I pediatric trauma center during the Covid-19 pandemic. METHODS A retrospective review of patients at our center was conducted to identify injuries caused by PCA in the month following the statewide closure of childcare facilities in Maryland. The proportion of PCA patients treated during the Covid-19 era were compared to the corresponding period in the preceding two years by Fisher's exact test. Demographics, injury profiles, and outcomes were described for each period. RESULTS Eight patients with PCA injuries were treated during the Covid-19 period (13 % of total trauma patients), compared to four in 2019 (4 %, p < 0.05) and three in 2018 (3 %, p < 0.05). The median age of patients in the Covid-19 period was 11.5 months (IQR 6.8-24.5). Most patients were black (75 %) with public health insurance (75 %). All injuries were caused by blunt trauma, resulting in scalp/face contusions (63 %), skull fractures (50 %), intracranial hemorrhage (38 %), and long bone fractures (25 %). CONCLUSIONS There was an increase in the proportion of traumatic injuries caused by physical child abuse at our center during the Covid-19 pandemic. Strategies to mitigate this secondary effect of social distancing should be thoughtfully implemented.
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Affiliation(s)
- Mark L Kovler
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Susan Ziegfeld
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Leticia M Ryan
- Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mitchell A Goldstein
- Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rebecca Gardner
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alejandro V Garcia
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Isam W Nasr
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Maiese A, Iannaccone F, Scatena A, Del Fante Z, Oliva A, Frati P, Fineschi V. Pediatric Abusive Head Trauma: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11040734. [PMID: 33924220 PMCID: PMC8074611 DOI: 10.3390/diagnostics11040734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 02/03/2023] Open
Abstract
Abusive head trauma (AHT) represents a commonly misdiagnosed condition. In fact, there is no pathognomonic sign that allows the diagnosis in children. Therefore, it is such an important medico-legal challenge to evaluate reliable diagnostic tools. The aim of this review is to evaluate the current scientific evidence to assess what the best practice is in order to diagnose AHT. We have focused particularly on evaluating the importance of circumstantial evidence, clinical history, the use of postmortem radiological examinations (such as CT and MRI), and the performance of the autopsy. After autopsy, histological examination of the eye and brain play an important role, with attention paid to correlation with symptoms found in vivo.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (F.I.); (A.S.)
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy;
| | - Francesca Iannaccone
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (F.I.); (A.S.)
| | - Andrea Scatena
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (A.M.); (F.I.); (A.S.)
| | - Zoe Del Fante
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy;
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, 00100 Rome, Italy;
| | - Paola Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy;
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy;
| | - Vittorio Fineschi
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy;
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy;
- Correspondence: ; Tel.: +39-064-991-2722
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Miley AE, Fisher AP, Moscato EL, Culp A, Mitchell MJ, Hindert KC, Makoroff KL, Rhine TD, Wade SL. A mixed-methods analysis examining child and family needs following early brain injury. Disabil Rehabil 2021; 44:3566-3576. [PMID: 33459078 DOI: 10.1080/09638288.2020.1870757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose:To understand child and family needs following TBI in early childhood, 22 caregivers of children who were hospitalized for a moderate to severe TBI between the ages of 0 and 4 within the past 10 years (M = 3.27 years; Range = 3 months to 8 years) participated in a needs assessment.Methods: Through a convergent study design, including focus groups (FG), key informant interviews (KII), and standardized questionnaires, caregivers discussed challenges and changes in their child's behaviors and functioning in addition to resources that would be helpful post-injury. Standardized questionnaires assessing current psychological distress and parenting stress in addition to open-ended questions about their general experience were completed.Results: Results indicated some families continue to experience unresolved concerns relating to the child's injury, caregiver wellbeing, and the family system after early TBI, including notable variation in caregiver reported psychological distress and parenting stress. Caregivers noted unmet needs post-injury, such as child behavior management and caregiver stress and coping.Conclusion: Early TBI can have a long-term impact on the child, caregivers, and family system. Addressing the needs of the whole family system in intervention and rehabilitation efforts may optimize outcomes following early TBI. Study results will inform intervention development to facilitate post-injury coping and positive parenting.IMPLICATIONS FOR REHABILITATIONEarly TBI can result in unmet needs that have a lingering impact on the child, caregiver, and family.Caregivers need information and resources that address their own distress and stressors related to changes in the child post-injury.Our study suggests that stress management and self-care skills are possible targets of intervention for caregivers of children who experienced an early TBI.
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Affiliation(s)
- Aimee E Miley
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison P Fisher
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Emily L Moscato
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA
| | - Aubrey Culp
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Monica J Mitchell
- Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kellana C Hindert
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathi L Makoroff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tara D Rhine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, University of Cincinnati College of Arts and Science, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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12
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Yilmaz G, Alemdar DK. Evaluation of Pediatric Forensic Cases Admitted to the Emergency Department in Turkey: A Retrospective Analysis. J Forensic Nurs 2021; 17:E1-E8. [PMID: 33350664 DOI: 10.1097/jfn.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The aim of this study was to determine retrospectively the demographic characteristics of forensic cases aged 0-18 years who were admitted to the emergency department. METHOD A total of 14,352 pediatric forensic cases aged 0-18 years, who were admitted to the emergency department of a hospital, were analyzed retrospectively in terms of the date of presentation, age, gender, and type of case. RESULTS Among the pediatric cases presenting to the emergency department, 56% were due to falling, 19% were due to burns, 8.5% were due to poisoning, 7.4% were due to animal bites, 5.3% were due to traffic accidents, 3.4% were due to battery, and 0.4% were due to other phenomena (electric shock and sexual abuse). Examination of the distribution of cases in terms of age showed that falling (16.4%), burns (25.7%), and poisoning (28%) were more frequent in boys in the age group of 15-18 months and in girls in the age group of 0-12 months. Presenting to the emergency department because of sexual abuse was observed to be more frequent in girls in the age groups of 10-14 years (40%) and 15-18 years (26.7%). CONCLUSION The high rates of falling, burns, and poisoning cases among children observed in this study suggest that child neglect and abuse were high and reveal the necessity of the presence of forensic nurses in the emergency departments.
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Affiliation(s)
- Gamze Yilmaz
- Author Affiliations:Ağri I˙brahim Çeçen University, School of Health, Ağri, Turkey
| | - Dilek Küçük Alemdar
- Ordu University Health Science Faculty, Department of Pediatric Nursing, Ordu, Turkey
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13
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Goldman T, Burjonrappa S. Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center. Int J Pediatr 2020; 2020:6621992. [PMID: 33456474 DOI: 10.1155/2020/6621992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Pediatric nonaccidental trauma (NAT) is difficult to diagnose. Several isolated injuries in NAT could happen in the setting of accidental trauma (AT), and having a high index of suspicion is important to correctly identify abuse. NAT has a significant mortality rate if the sentinel event is not adequately diagnosed, and the infant is not separated from the perpetrator. Level 1 pediatric trauma centers (PTC) see a significant number of NAT. We evaluated the injury patterns of NAT admissions at our level 1 PTC. Methods Retrospective analysis of all cases of NAT for children under the age of two admitted at an ACS level 1 pediatric trauma center between the years of 2016 and 2018. Charts were queried for demographic data, injury patterns, mortality, and disposition. Correlation between disposition status and injury patterns was performed. The Fisher Exact test and student t-test were used to study the significance of differences in categorical and continuous data, respectively. Results 32/91 (35%) trauma patients under the age of two years were diagnosed as NAT in the three-year study period. 21/32 (39%) male and 11/26 (42%) female admissions were confirmed NAT (p = NS). 20 were under 1 year of age, and 12 were aged between 1 and 2 years (p = NS). 13 (41%) were Caucasian, 6 (19%) were Hispanic/Latino, 11 (34%) were Black, and 2(6%) were of unknown ethnicity (p = NS). Facial, torso, lower extremity, retinal, and internal organ injury were significantly more common with NAT. Medicaid coverage was noted in 31/32 (97%) NAT patients. 20/32 (62.5%) patients were legally displaced as a result of the NAT. Conclusion 1/3rd of all admissions at a pediatric level 1 trauma center were identified as NAT. A high index of suspicion is necessary to not miss NAT, as injury patterns are variable. Nearly 1/3rd of all victims go back to the same environment where they sustained NAT increasing their susceptibility to future NAT.
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14
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Ghadersohi S, Francom CR, Prager JD. Non-accidental trauma presenting with nasal septal hematoma or abscess. Int J Pediatr Otorhinolaryngol 2020; 139:110460. [PMID: 33091809 DOI: 10.1016/j.ijporl.2020.110460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Failure to diagnose non-accidental trauma (NAT) leaves the victim at risk of further injury or even death. It is incumbent upon physicians and other health care personnel to identify trauma patterns that have a high likelihood of being caused by NAT. The objective of this study is to discuss the presentation of nasal septal hematoma (NSH) or nasal septal abscess (NSA) as a sign of NAT. METHODS This is a retrospective case series of patients presenting with nasal septal hematoma or abscess between 2010 and 2019. The primary endpoint was the etiology of the injury. Secondary endpoints included demographics, concomitant injuries and treatments rendered. RESULTS There were 28 patients who presented with septal hematoma or abscess. The etiologies included 20 (71.4%) due to accidental trauma, four (13.8%) with NAT, one infectious, and three unknown. All four NAT patients were male and infants with an average age of 5.4 months (SD 4.6) significantly (p = 0.0069) younger than 10.3 years (SD 5.1) in the accidental trauma group. There was a delayed time to presentation for the NAT patients compared to other etiologies. Two of four NAT patients were initially thought to have a congenital midline nasal dermoid, yet surgical intervention revealed a hematoma. Further NAT evaluation noted concomitant injuries including rib fractures and intracranial injuries in 75% of the NAT patients. CONCLUSIONS Presentation of a child with NSH/NSA prior to the onset of ambulation or with a delayed time to presentation should prompt suspicion and further workup for NAT.
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Affiliation(s)
- S Ghadersohi
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA.
| | - C R Francom
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | - J D Prager
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
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15
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Ajmera S, Motiwala M, Weeks M, Oravec CS, Hersh DS, Fraser BD, Vaughn B, Klimo P. What Variables Correlate With Different Clinical Outcomes of Abusive Head Injury? Neurosurgery 2020; 87:803-810. [PMID: 32243538 DOI: 10.1093/neuros/nyaa058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The spectrum of injury severity for abusive head trauma (AHT) severity is broad, but outcomes are unequivocally worse than accidental trauma. There are few publications that analyze different outcomes of AHT. OBJECTIVE To determine variables associated with different outcomes of AHT. METHODS Patients were identified using our AHT database. Three different, but not mutually exclusive, outcomes of AHT were modeled: (1) death or hemispheric stroke (diffuse loss of grey-white differentiation); (2) stroke(s) of any size; and (3) need for a neurosurgical operation. Demographic and clinical variables were collected and correlations to the 3 outcomes of interest were identified using bivariate and multivariable analysis. RESULTS From January 2009 to December 2017, 305 children were identified through a prospectively maintained AHT database. These children were typically male (60%), African American (54%), and had public or no insurance (90%). A total of 29 children (9.5%) died or suffered a massive hemispheric stroke, 57 (18.7%) required a neurosurgical operation, and 91 (29.8%) sustained 1 or more stroke. Death or hemispheric stroke was statistically associated with the pupillary exam (odds ratio [OR] = 45.7) and admission international normalized ratio (INR) (OR = 17.3); stroke was associated with the pupillary exam (OR = 13.2), seizures (OR = 14.8), admission hematocrit (OR = 0.92), and INR (9.4), and need for surgery was associated with seizures (OR = 8.6). CONCLUSION We have identified several demographic and clinical variables that correlate with 3 clinically applicable outcomes of abusive head injury.
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Affiliation(s)
- Sonia Ajmera
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Chesney S Oravec
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David S Hersh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brittany D Fraser
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey Clinic, Memphis, Tennessee
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16
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Rosenfeld EH, Johnson B, Wesson DE, Shah SR, Vogel AM, Naik-Mathuria B. Understanding non-accidental trauma in the United States: A national trauma databank study. J Pediatr Surg 2020; 55:693-697. [PMID: 31103270 DOI: 10.1016/j.jpedsurg.2019.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/07/2019] [Accepted: 03/28/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study is to characterize the epidemiology, injury patterns, outcomes and trends of non-accidental trauma (NAT) in the United States using a large national database. METHODS Children <15 years presenting after NAT were identified in the 2007-2014 National Trauma Databank research datasets. Clinical and outcome data were analyzed using descriptive statistics, chi-square and logistic regression. RESULTS Of 678,503 children admitted for traumatic injuries, 3% (19,149) were victims of NAT. The majority (95%) were under 5 years and 71% under 1 year old. The majority (59%) were male. The median injury severity score (ISS) was 10 (IQR:5-19). African Americans were disproportionally affected (27% vs 17% of all traumas), and the majority had public or no insurance (85%). Incidence was highest in the midwest and lowest in the northeast regions of the country, although trends varied over time. NAT resulted in 43% of trauma deaths in children <1 year and 31% of trauma deaths in children <5. Traumatic brain injury (TBI) was the most commonly encountered diagnosis (50%). Polytrauma was common, and certain injury patterns were identified. Urgent operation was required in 6%, 43% were admitted to intensive care, and 9% died. Mortality was independently associated with TBI, thoracic injury, hollow viscus injury and older age. CONCLUSION Non-accidental trauma is a leading cause of trauma mortality in young children. Multiple injuries are common, requiring comprehensive evaluation and early surgical involvement. The data presented in this study could serve as a guide to target injury prevention efforts. LEVEL OF EVIDENCE III STUDY TYPE: Prognostic and Epidemiological.
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Affiliation(s)
- Eric H Rosenfeld
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Brittany Johnson
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - David E Wesson
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Sohail R Shah
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Adam M Vogel
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Bindi Naik-Mathuria
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
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17
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Cohn JE, Licata JJ, Othman S, Shokri T, Zwillenberg S. Comparison of Maxillofacial Trauma Patterns in the Urban Versus Suburban Environment: A Pilot Study. Craniomaxillofac Trauma Reconstr 2020; 13:115-121. [PMID: 32642042 DOI: 10.1177/1943387520910338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Assault appears to be the most frequent cause of facial fractures in certain urban trauma centers, possibly due to the ease of acquiring weapons and increasingly aggressive behavior. The objectives of this study were to identify specific demographic, socioeconomic, maxillofacial fracture, and assault patterns in urban versus suburban communities. Methods A retrospective chart review of patients who sustained maxillofacial fractures from August 2014 through August 2016 at one urban campus, Einstein Medical Center, Philadelphia, and two suburban campuses, Einstein Medical Center Montgomery and Elkins Park. The χ2 testing was used to compare the categorical variables between the 2 groups. Results A total of 259 maxillofacial trauma patients were identified, with 204 (79%) in the urban and 55 (21%) in the suburban environment. Patients in the urban population were more likely to be African American (70% vs 33%) and Hispanic (15% vs 6%) but less likely to be Caucasian (12% vs 55%, P < .0001). Urban patients were more likely to be single (70% vs 47%, P < .01), unemployed (64% vs 44%, P < .001), and receive Medicaid coverage (58% vs 26%, P < .001). Urban patients were more likely to be victims of assault (63% vs 44%), whereas suburban patients were more likely to sustain accidental injuries (16% vs 2%, P < .0001). Urban victims were more likely to be assaulted with an object (30% vs 12%) or gun (7% vs 0%, P = .05). Conclusion Maxillofacial trauma patterns were shown to be significantly different in the urban versus suburban environment.
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Affiliation(s)
- Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Jordan J Licata
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Sammy Othman
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Seth Zwillenberg
- Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA, USA
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18
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Kennedy JM, Lazoritz S, Palusci VJ. Risk Factors for Child Maltreatment Fatalities in a National Pediatric Inpatient Database. Hosp Pediatr 2020; 10:230-237. [PMID: 32054640 PMCID: PMC7041552 DOI: 10.1542/hpeds.2019-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Child maltreatment (CM) is recognized as a major public health concern, and an important number of children suffer injuries related to abuse and neglect that result in death. We sought to identify risk factors for CM fatalities among hospitalized children that can provide clinicians with information to recognize at-risk children and reduce further death. METHODS In this study, we included cases from the 2012 Kids' Inpatient Database with diagnosis codes related to CM who were <5 years of age and were not transferred to another facility. Potential demographic and clinical risk factors were identified and compared to child fatality in the hospital by using bivariate and multivariate analyses. To assess how cases coded specifically for maltreatment differed from similar cases that only suggested maltreatment, a reduced-model multivariable logistic regression for fatality was created. RESULTS We found 10 825 children <5 years who had inpatient diagnoses coded in their medical record for CM. Most demographic variables (age, race, and sex) were not significantly associated with fatality, whereas clinical variables (transferring in, drowning, ingestions, and burns) were significantly associated with fatality. There were regional differences on the basis of hospital location as well as significantly more chronic conditions, procedure charges, and longer lengths of stay among children who died. Controlling for significant risk factors, those with diagnoses specific for physical abuse had ∼3 times the odds of dying (odds ratio = 2.797; 95% confidence interval: 1.941-4.031). CONCLUSIONS In this study, although infancy and decreased income were associated with increased risk for fatality, more important factors were the types of injuries the child endured and whether the inpatient clinician had identified specific injuries indicating physical abuse.
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Affiliation(s)
- Juliana M Kennedy
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York; and
| | | | - Vincent J Palusci
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York; and
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19
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Escobar MA Jr, Wallenstein KG, Christison-Lagay ER, Naiditch JA, Petty JK. Child abuse and the pediatric surgeon: A position statement from the Trauma Committee, the Board of Governors and the Membership of the American Pediatric Surgical Association. J Pediatr Surg 2019; 54:1277-85. [PMID: 30948199 DOI: 10.1016/j.jpedsurg.2019.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/24/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pediatric surgeon is in a unique position to assess, stabilize, and manage a victim of child physical abuse (formerly nonaccidental trauma [NAT]) in the setting of a formal trauma system. METHODS The American Pediatric Surgical Association (APSA) endorses the concept of child physical abuse as a traumatic disease that justifies the resource utilization of a trauma system to appropriately evaluate and manage this patient population including evaluation by pediatric surgeons. RESULTS APSA recommends the implementation of a standardized tool to screen for child physical abuse at all state designated trauma or ACS verified trauma and children's surgery hospitals. APSA encourages the admission of a suspected child abuse patient to a surgical trauma service because of the potential for polytrauma and increased severity of injury and to provide reliable coordination of services. Nevertheless, APSA recognizes the need for pediatric surgeons to participate in a multidisciplinary team including child abuse pediatricians, social work, and Child Protective Services (CPS) to coordinate the screening, evaluation, and management of patients with suspected child physical abuse. Finally, APSA recognizes that if a pediatric surgeon suspects abuse, a report to CPS for further investigation is mandated by law. CONCLUSION APSA supports data accrual on abuse screening and diagnosis into a trauma registry, the NTDB and the Pediatric ACS TQIP® for benchmarking purposes and quality improvement.
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