TY - JOUR
T1 - The prevalence of non-accidental trauma among children with polytrauma
T2 - A nationwide level-I trauma centre study
AU - Loos, Marie-Louise H. J.
AU - van Rijn, Rick R.
AU - Krug, Egbert
AU - Bloemers, Frank W.
AU - ten Bosch, Jan A.
AU - Bossuyt, P. M. M.
AU - Edwards, Michael J. R.
AU - Greeven, Alexander P. A.
AU - Hulscher, Jan B. F.
AU - Keyzer-Dekker, Claudia M. G.
AU - de Ridder, Victor A.
AU - Spanjersberg, W. Richard
AU - Teeuw, Arianne H.
AU - Theeuwes, Hilco P.
AU - de Vries, Selena
AU - de Wit, Ralph
AU - Bakx, Roel
AU - de Boer, Anne
AU - Edelenbos, Esther
AU - Goslings, J. Carel
AU - van Sommeren, Lia P. G. W.
AU - Toor, Annelies
AU - Affourtit, Marjo
AU - van Ditshuizen, Jan C.
AU - Wijnen, Rene M. H.
AU - Kempink, Dagmar R. J.
AU - Bessems, Johannes H. JM.
AU - Hagenaars, Tjebbe
AU - den Hartog, Dennis
AU - Jansen, M. A. C.
AU - Allema, J. H.
AU - Kanters, Floris E. P.
AU - Aalbers-Hiemstra, Annemieke
AU - Mulder, Arnaud
AU - Smiers, Frans
AU - Hartendorf, Rina C.
AU - Fiddelers, Audrey A. A.
AU - Levelink, Birgit
AU - Poeze, Martijn
AU - de Blaauw, Ivo
AU - Tromp, Tjarda N.
AU - Beuker, Benn
AU - Reininga, Inge
AU - Wendt, Klaus
AU - Aspers-Wolters, Stasja J. G.
AU - RAFIKI study group
AU - van de Putte, Elise M.
N1 - Funding Information: This work was supported by the Louise Vehmeijer foundation [funding reference number 2016-007V ] the Netherlands. Funding Information: Secondly, as Davies et al. wrote, trauma networks need to adapt their response in order to improve patient outcomes.6 It is important to identify NAT as soon as possible, in order to ensure the safety of children during and after admission. Failure to recognize NAT can result in future injuries and death.6,33 The Advanced Trauma Life Support protocol® and the Advanced Pediatric Life Support protocol®34 are used at the ED, where the primary survey focuses on life-saving treatment during the ‘golden hour’. During the secondary- but certainly during the tertiary survey, doctors need to pay attention to NAT as a cause of polytrauma. Recognizing NAT at hospitals creates a window of opportunity to intervene. An intervention can stop continuous abuse and possible interrupt the circle of violence. Hoytema et al. showed a positive impact of interventions after ED admission.35 In order to improve the detection of NAT, we believe that the determined indicators in our study should be further analysed. It may be possible to design a predication model for NAT to be used during secondary survey or tertiary survey in combination with clinical history.This work was supported by the Louise Vehmeijer foundation [funding reference number 2016-007V] the Netherlands. Publisher Copyright: © 2022
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Objective: We aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC). Summary of background: Data 6–10% Of children who present at the emergency department with injuries, sustain polytrauma. Polytrauma may result from either accidental (AT) or NAT, i.e. inflicted or neglect. The prevalence of NAT among children with polytrauma is currently unclear. Methods: This is a retrospective study that included children (0–18 years) with an Injury Severity Score >15, who presented at one of the 11 Level-I trauma centers (TC) in the Netherlands between January 1, 2010 and January 1, 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect-team. Cases in which conclusions were unavailable and there was no clear accidental cause of injuries were reviewed by an expert panel. Results: The study included 1623 children, 1452 (89%) were classified as AT, 171 (11%) as NAT; 39 (2,4%) inflicted and 132 (8,1%) neglect. Of pre-school aged children (<5 years) 41% sustained NAT (OR26.73, 95%CI 17.70–40.35), 35/342 (10%) inflicted and 104/342 (31%) neglect. Admission due to ‘cardiopulmonary arrest’ was the result of inflicted trauma (30% vs 0%,p < 0.001). NAT had a higher mortality rate (16% vs 10%, p = 0.006). Indicators of NAT were: (near-)drowning (OR10.74, 95%CI 5.94–19.41), burn (OR8.62, 95%CI 4.08–18.19) and fall from height (OR2.18, 95%CI 1.56–3.02). Conclusions: NAT was the cause of polytrauma in 11% of children in our nationwide level-I TC study; 41% of these polytrauma were the result of NAT experienced by preschool-aged children. Our data show the importance of awareness for NAT.
AB - Objective: We aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC). Summary of background: Data 6–10% Of children who present at the emergency department with injuries, sustain polytrauma. Polytrauma may result from either accidental (AT) or NAT, i.e. inflicted or neglect. The prevalence of NAT among children with polytrauma is currently unclear. Methods: This is a retrospective study that included children (0–18 years) with an Injury Severity Score >15, who presented at one of the 11 Level-I trauma centers (TC) in the Netherlands between January 1, 2010 and January 1, 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect-team. Cases in which conclusions were unavailable and there was no clear accidental cause of injuries were reviewed by an expert panel. Results: The study included 1623 children, 1452 (89%) were classified as AT, 171 (11%) as NAT; 39 (2,4%) inflicted and 132 (8,1%) neglect. Of pre-school aged children (<5 years) 41% sustained NAT (OR26.73, 95%CI 17.70–40.35), 35/342 (10%) inflicted and 104/342 (31%) neglect. Admission due to ‘cardiopulmonary arrest’ was the result of inflicted trauma (30% vs 0%,p < 0.001). NAT had a higher mortality rate (16% vs 10%, p = 0.006). Indicators of NAT were: (near-)drowning (OR10.74, 95%CI 5.94–19.41), burn (OR8.62, 95%CI 4.08–18.19) and fall from height (OR2.18, 95%CI 1.56–3.02). Conclusions: NAT was the cause of polytrauma in 11% of children in our nationwide level-I TC study; 41% of these polytrauma were the result of NAT experienced by preschool-aged children. Our data show the importance of awareness for NAT.
KW - Accidental
KW - Child abuse
KW - Neglect
KW - Non-accidental
KW - Pediatric trauma
KW - Polytrauma
UR - http://www.scopus.com/inward/record.url?scp=85133588841&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jflm.2022.102386
DO - https://doi.org/10.1016/j.jflm.2022.102386
M3 - Article
C2 - 35839691
SN - 1752-928X
VL - 90
JO - Journal of forensic and legal medicine
JF - Journal of forensic and legal medicine
M1 - 102386
ER -