 |
|
Child Abuse and Unintentional Injuries
A 10-Year Retrospective
Carla DiScala, PhD;
Robert Sege, MD;
Guohua Li, MD, DrPH;
Robert M. Reece, MD
Arch Pediatr Adolesc Med. 2000;154:16-22.
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 age.
Main Outcome Measures Patient characteristics, nature and severity of injury, treatment, length of stay, survival, functional limitations, and disposition at discharge from the hospital.
Data Source Retrospective review of medical records submitted to the National Pediatric Trauma Registry between January 1, 1988, and December 31, 1997.
Results During the 10-year study period, child abuse accounted for 10.6% of all blunt trauma to patients younger than 5 years. Children injured by child abuse were significantly younger (mean, 12.8 vs 25.5 months) and were more likely to have preinjury medical history (53% vs 14.1%) and retinal hemorrhages (27.8% vs 0.06%) than children with unintentional injuries. Abused children were mainly injured by battering (53%) and by shaking (10.3%); unintentionally injured children were hurt mainly by falls (58.4%) and by motor vehicle–related events (37.1%). Abused children were more likely than unintentionally 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; to sustain very severe injuries (22.6% vs 6.3%); to be admitted to the intensive 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 length 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 those unintentionally injured. Among the survivors, children who were abused developed extensive functional limitations more frequently than those unintentionally injured (8.7% vs 2.7%). More than half (56.6%) of the children who were abused were discharged to custodial/foster/Child Protective Services care; most (96.1%) of the children unintentionally injured returned to their homes.
Conclusions Child abuse continues to be a serious cause of mortality and morbidity to infants and toddlers. On average, among children hospitalized for blunt trauma, those injured by abuse sustain more severe injuries, use more medical services, and have worse survival and functional outcome than children with unintentional injuries.
From the Departments of Physical Medicine and Rehabilitation (Dr DiScala) and Pediatrics (Drs DiScala, Sege, and Reece), Tufts University School of Medicine, Boston, Mass; and the Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Md (Dr Li).
RELATED ARTICLES
Childhood Head Injuries: Accidental or Inflicted?
Robert M. Reece and Robert Sege
Arch Pediatr Adolesc Med. 2000;154(1):11-15.
ABSTRACT
| FULL TEXT
Recognition of Child Abuse: Notes From the Field
Daniel L. Coury
Arch Pediatr Adolesc Med. 2000;154(1):9-10.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Retinal Hemorrhages in Children Following Fatal Motor Vehicle Crashes: A Case Series
Kivlin et al.
Arch Ophthalmol 2008;126:800-804.
ABSTRACT
| FULL TEXT
Cost-effectiveness of Head Computed Tomography in Infants With Possible Inflicted Traumatic Brain Injury
Campbell et al.
Pediatrics 2007;120:295-304.
ABSTRACT
| FULL TEXT
Prehospital and In-Hospital Mortality: A Comparison of Intentional and Unintentional Traumatic Brain Injuries in Colorado Children
Sills et al.
Arch Pediatr Adolesc Med 2005;159:665-670.
ABSTRACT
| FULL TEXT
Outcomes in Children and Young Adults Who Are Hospitalized for Firearms-Related Injuries
DiScala and Sege
Pediatrics 2004;113:1306-1312.
ABSTRACT
| FULL TEXT
The Economic Burden of Hospitalizations Associated With Child Abuse and Neglect
Rovi et al.
Am. J. Public Health 2004;94:586-590.
ABSTRACT
| FULL TEXT
Blunt Abdominal Injury in the Young Pediatric Patient: Child Abuse and Patient Outcomes
Trokel et al.
Child Maltreat 2004;9:111-117.
ABSTRACT
Costs of Childhood Physical Abuse: Comparing Inflicted and Unintentional Traumatic Brain Injuries
Libby et al.
Pediatrics 2003;112:58-65.
ABSTRACT
| FULL TEXT
From the Archives of the AFIP: Child Abuse: Radiologic-Pathologic Correlation
Lonergan et al.
RadioGraphics 2003;23:811-845.
ABSTRACT
| FULL TEXT
Rates of Pediatric Injuries by 3-Month Intervals for Children 0 to 3 Years of Age
Agran et al.
Pediatrics 2003;111:e683-692.
ABSTRACT
| FULL TEXT
Injuries to Children Who Had Preinjury Cognitive Impairment: A 10-Year Retrospective Review
Braden et al.
Arch Pediatr Adolesc Med 2003;157:336-340.
ABSTRACT
| FULL TEXT
Can the Initial History Predict Whether a Child With a Head Injury Has Been Abused?
Hettler and Greenes
Pediatrics 2003;111:602-607.
ABSTRACT
| FULL TEXT
Intracranial Hemorrhage in Children Younger Than 3 Years: Prediction of Intent
Wells et al.
Arch Pediatr Adolesc Med 2002;156:252-257.
ABSTRACT
| FULL TEXT
Serious Injuries and Deaths of Adolescent Girls Resulting From Interpersonal Violence: Characteristics and Trends From the United States, 1989-1998
Moskowitz et al.
Arch Pediatr Adolesc Med 2001;155:903-908.
ABSTRACT
| FULL TEXT
Children hospitalized early and increased risk for future serious injury
McPhillips et al.
Inj. Prev. 2001;7:150-154.
ABSTRACT
| FULL TEXT
Clues to Identify Child Abuse
Journal Watch Dermatology 2000;2000:21-21.
FULL TEXT
Clues to Identify Child Abuse
JWatch Psychiatry 2000;2000:16-16.
FULL TEXT
Clues To Identify Child Abuse
JWatch General 2000;2000:4-4.
FULL TEXT
Recognition of Child Abuse: Notes From the Field
Coury
Arch Pediatr Adolesc Med 2000;154:9-10.
FULL TEXT
Childhood Head Injuries: Accidental or Inflicted?
Reece and Sege
Arch Pediatr Adolesc Med 2000;154:11-15.
ABSTRACT
| FULL TEXT
|
