The tip of the iceberg for child abuse: The critical roles of the pediatric trauma service and its registry

David C. Chang, Vinita Knight, Susan Ziegfeld, Adil Haider, Dawn Warfield, Charles Paidas

Research output: Contribution to journalArticle

Abstract

Background: The incidence of child abuse is approximately 10% of all children presenting to an emergency department (ED), with a mortality rate less than 1%. By contrast, the characteristics of the subset of abused children presenting to a pediatric trauma service (PTS) is not well defined. Methods: This study was a retrospective evaluation of prospectively collected information from an urban Level I pediatric trauma registry from 1990 to 2002 (n = 11,919). Child abuse cases and their perpetrators were identified by E-codes. Patterns of injuries were examined by integer International Classification of Diseases, Ninth Revision codes, and diagnostic model was evaluated by discrimination and goodness-of-fit. Results: A total of 171 cases of child abuse (1.4%) were identified, and the majority were boys (59%, p > 0.05 vs. non-abuse cases). The median age of the abused cohort was younger than 1 year old, and the number of abuse cases did not differ over time (mean, 11 per year.) Abused children present with a higher median Injury Severity Score (10 vs. 4, p <0.01), more severe injuries of the head and integument, longer hospital lengths of stay (4 vs. 1 day, p <0.01), and a higher mortality rate (12% vs. 2%, p <0.01). The following variables emerged with significant association to abuse: fracture of base or vault of skull, contusion of eye, rib fracture, intracranial bleeding, multiple burns, and age. A new Diagnostic Index for Physical Child Abuse was created. Conclusion: Significant characteristics of the abused children in this pediatric trauma service include higher Injury Severity Score (especially in the head and integument), requirement for longer lengths of stay, and a nearly 10-times higher risk of death compared with the ED population. The Diagnostic Index for Physical Child Abuse is proposed as a new tool to assist in the identification of child abuse among pediatric trauma patients. An epidemiologic triangle for child abuse is described, with different prevalence and severity of child abuse seen at different levels of our health care system, starting with primary care providers, followed by the ED, the PTS, and ultimately the medical examiners. The number of cases decreases from the bottom to the top of the health care system, but the mortality rate increases as abuse escalates through the triangle. This establishes the PTS as possibly the final gatekeeper before an abused case becomes a fatality. These data emphasize the need for rigorous registry evaluation and subsequent evidence-based prevention initiatives.

Original languageEnglish (US)
Pages (from-to)1189-1198
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume57
Issue number6
DOIs
StatePublished - Dec 2004
Externally publishedYes

Fingerprint

Child Abuse
Registries
Pediatrics
Wounds and Injuries
Hospital Emergency Service
Length of Stay
Injury Severity Score
Mortality
Rib Fractures
Delivery of Health Care
Coroners and Medical Examiners
Contusions
International Classification of Diseases
Burns
Craniocerebral Trauma
Skull
Health Status
Primary Health Care
Head
Hemorrhage

Keywords

  • Child abuse
  • Diagnostic index
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

The tip of the iceberg for child abuse : The critical roles of the pediatric trauma service and its registry. / Chang, David C.; Knight, Vinita; Ziegfeld, Susan; Haider, Adil; Warfield, Dawn; Paidas, Charles.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 57, No. 6, 12.2004, p. 1189-1198.

Research output: Contribution to journalArticle

Chang, David C. ; Knight, Vinita ; Ziegfeld, Susan ; Haider, Adil ; Warfield, Dawn ; Paidas, Charles. / The tip of the iceberg for child abuse : The critical roles of the pediatric trauma service and its registry. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 57, No. 6. pp. 1189-1198.
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