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Child/Adolescent Health

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Children's hospitals are much more likely than general hospitals to diagnose child abuse in severely injured infants

Approximately 1,300 U.S. children died as a result of abuse in 2001. Diagnosing child abuse is difficult, particularly in abused infants. A new study recently found that children's hospitals were more than twice as likely to diagnose child abuse in severely injured infants than general hospitals (29 vs. 13 percent), where most injured children receive care. General hospitals with a children's unit identified more abuse cases (19 percent) than general hospitals without a children's unit, but fewer than a children's hospital. The study was led by Matthew Trokel, M.D., of Boston Medical Center, and supported in part by the Agency for Healthcare Research and Quality (T32 HS00060).

Researchers analyzed 1997 hospital discharge data from the Kids' Inpatient Database of the Healthcare Cost and Utilization Project to examine abuse diagnosis by hospital type for children less than 1 year old. Overall, they analyzed the diagnoses of 2,253 infants who were admitted to U.S. hospitals in 1997 for treatment of traumatic brain injury or femur fracture. When these injuries do not result from either penetrating trauma or motor vehicle accidents, they are often caused by child abuse. An additional 178 infants (39 percent of the total) with these specific injuries would have been diagnosed as abused had they been treated at children's rather than general hospitals, even after controlling for patient and hospital factors, note the researchers.

Nearly half (49 percent) of the infants studied were admitted to general hospitals. One-fourth of infants were admitted to general hospitals with children's units, and the remaining one-fourth were admitted to a children's hospital. Children who were treated at children's hospitals tended to be younger, more severely injured, and more likely to have private health insurance than those cared for at general hospitals. The researchers suggest that the variation in abuse diagnoses may result from systematic underdiagnosis of abuse in general hospitals.

See "Variation in the diagnosis of child abuse in severely injured infants," by Dr. Trokel, Anthony Wadimmba, M.B., Ch.B., John Griffith, Ph.D., and Robert Sege, M.D., Ph.D., in the March 2006 Pediatrics 117(3), pp. 722-728.

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