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Child abuse is associated with increased risk of death in young children with abdominal injuries

Between 1995 and 2001, more than half (61 percent) of traumatic abdominal injuries in young children 0 to 4 years of age were the result of motor vehicle accidents. Other significant causes were child abuse (16 percent) and falls (14 percent). These figures are based on an analysis of data provided by U.S. pediatric trauma hospitals to the National Pediatric Trauma Registry. Children who were abused and those with concomitant central nervous system (CNS) injury were more likely than other children with abdominal trauma to die while in the hospital, according to the study, which was supported in part by the Agency for Healthcare Research and Quality (T32 HS00060).

Matthew Trokel, M.D., M.S., and colleagues from Tufts-New England Medical Center identified 927 cases of blunt abdominal injuries from the Registry, which includes data on the causes, treatment, and consequences of pediatric trauma. They examined hospital use and patient outcomes for these trauma victims. Among children injured in motor vehicle accidents, the severe multisystem-injury group had the highest rates of inappropriate car restraint device use (66 percent), almost double that of the isolated abdominal injury group (38 percent). Children with all three systems injured (abdominal, skeletal, and traumatic brain injury or TBI) had the longest median length of hospital stay (10 days), the highest ICU admission rate (89 percent), and the highest surgery rate (40 percent). Children with two body systems injured had less intensive use of hospital resources but more than children with abdominal injury alone.

Patient outcomes also varied according to the associated injuries. Children with abdominal injuries and fracture had outcomes similar to those for children with isolated abdominal injury, but they had an increase in home rehabilitation referral (5.9 percent vs. 0.9 percent). Children with TBI, with or without fractures, had an almost nine-fold increase in in-hospital death rate (27 vs. 3 percent) and a 6.5 fold increase (48 vs. 7 percent) in the rate of rehabilitation referral compared with those who did not have TBI. Child abuse was associated with higher death rates across all injury groups compared with all other mechanisms of injury, perhaps due to delay in seeking medical care.

See "Blunt abdominal injury in the young pediatric patient: Child abuse and patient outcomes," by Matthew Trokel, M.D., Carla DiScala, Ph.D., Norma C. Terrin, Ph.D., and Robert D. Sege, M.D., Ph.D., in the February 2004 Child Maltreatment 9(1), pp. 111-117.

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