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Joskowitz K, Patwardhan UM, Floan GM, Heflinger M, Cruz S, David M, Jadhav P, Nienow S, Thangarajah H, Ignacio RC. Evaluating Outcomes of Nonaccidental Trauma in Military Children. J Am Coll Surg 2024; 238:801-807. [PMID: 38372360 DOI: 10.1097/xcs.0000000000001048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Nonaccidental trauma (NAT), or child abuse, is a leading cause of childhood injury and death in the US. Studies demonstrate that military-affiliated individuals are at greater risk of mental health complication and family violence, including child maltreatment. There is limited information about the outcomes of military children who experience NAT. This study compares the outcomes between military-dependent and civilian children diagnosed with NAT. STUDY DESIGN A single-institution, retrospective review of children admitted with confirmed NAT at a Level I trauma center was performed. Data were collected from the institutional trauma registry and the Child Abuse Team's database. Military affiliation was identified using insurance status and parental or caregiver self-reported active-duty status. Demographic and clinical data including hospital length of stay (LOS), morbidity, specialty consult, and mortality were compared. RESULTS Among 535 patients, 11.8% (n = 63) were military-affiliated. The median age of military-associated patients, 3 months (interquartile range [IQR] 1 to 7), was significantly younger than civilian patients, 7 months (IQR 3 to 18, p < 0.001). Military-affilif:ated patients had a longer LOS of 4 days (IQR 2 to 11) vs 2 days (IQR 1 to 7, p = 0.041), increased morbidity or complication (3 vs 2 counts, p = 0.002), and a higher mortality rate (10% vs 4%, p = 0.048). No significant difference was observed in the number of consults or injuries, trauma activation, or need for surgery. CONCLUSIONS Military-affiliated children diagnosed with NAT experience more adverse outcomes than civilian patients. Increased LOS, morbidity or complication, and mortality suggest military-affiliated patients experience more life-threatening NAT at a younger age. Larger studies are required to further examine this population and better support at-risk families.
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Affiliation(s)
- Katie Joskowitz
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Utsav M Patwardhan
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA (Patwardhan, Floan)
| | - Gretchen M Floan
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA (Patwardhan, Floan)
| | - Megan Heflinger
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Sheena Cruz
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Maya David
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Priyanka Jadhav
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Shalon Nienow
- Division of Child Abuse Pediatrics, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA (Nienow)
- Division of Child Abuse Pediatrics, Rady Children's Hospital-San Diego, San Diego, CA (Nienow)
- Chadwick Center for Children and Families at Rady Childrens Hospital, San Diego, CA (Nienow)
| | - Hari Thangarajah
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA (Thangarajah, Ignacio)
| | - Romeo C Ignacio
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA (Thangarajah, Ignacio)
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Jadhav P, Sears T, Floan G, Joskowitz K, Nienow S, Cruz S, David M, de Cos V, Choi P, Ignacio RC. Application of a Machine Learning Algorithm in Prediction of Abusive Head Trauma in Children. J Pediatr Surg 2024; 59:80-85. [PMID: 37858394 DOI: 10.1016/j.jpedsurg.2023.09.027] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE We explored the application of a machine learning algorithm for the timely detection of potential abusive head trauma (AHT) using the first free-text note of an encounter and demographic information. METHODS First free-text physician notes and demographic information were collected for children under 5 years of age at a Level 1 Trauma Center. The control group, which included patients with head/neck injury, was compared to those with AHT diagnosed by the Child Protective Team. Differential scores accounted for words overrepresented in AHT patient vs. control notes. Sentiment scores were reflective of note positivity/negativity and subjectivity scores accounted for note subjectivity/objectivity. The composite scores reflected the patient's differential score modified by the subjectivity score. Composite, sentiment, and subjectivity scores combined with demographic information trained a Random Forest (RF) machine learning algorithm to predict AHT. RESULTS Final composite scores with demographic information were highly associated with AHT in a test dataset. The control group included 587 patients and the test group included 193 patients. Combining composite scores with demographic information into the RF model improved AHT classification area under the curve (AUC) from 0.68 to 0.78, with an overall accuracy of 84%. Feature importance analysis of our RF model revealed that composite score, sentiment, age, and subjectivity were the most impactful predictors of AHT. The sentiment was not significantly different between control and AHT notes (p = 0.87), while subjectivity trended higher for AHT notes (p = 0.081). CONCLUSION We conclude that a machine learning algorithm can recognize patterns within free-text notes and demographic information that aid in AHT detection in children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Priyanka Jadhav
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Timothy Sears
- Department of Bioinformatics and Systems Biology Graduate Program, University of California San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Gretchen Floan
- Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA, 92134, USA
| | - Katie Joskowitz
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA, 92123, USA
| | - Shalon Nienow
- Department of Pediatrics, Division of Child Abuse Pediatrics, University of California-San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA; Chadwick Center for Children and Families at Rady Childrens Hospital, 3665 Kearny Villa Road, Suite 500, San Diego, CA, 92123, USA
| | - Sheena Cruz
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Maya David
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Víctor de Cos
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Pam Choi
- Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA, 92134, USA
| | - Romeo C Ignacio
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA; Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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