Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers.

Background: Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting. Extreme cases of child abuse, or non-accidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians that have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma Verification. It is hypothesized that ACS verified Pediatric Trauma Centers (vPTCs) have an increased prevalence of NAT due to this additional experience and training when relative to non-ACS vPTCs. Methods: The National Trauma Data Bank, for the years 2007 to 2014, was utilized to compare the prevalence of NAT between ACS vPTCs relative to non-ACS vPTCs to produce both crude and Injury Severity Score adjusted prevalence ratio estimates. Results: The majority of NAT cases across all hospitals were male (58.3%). The mean age of the NAT cases was 2.3 years with a mean injury severity score (ISS) of 11.1. The most common payment method was Medicaid (64.4%). The prevalence of NAT was 1.82 (1.74-1.90) times higher among ACS vPTCs and 1.81 (1.73, 1.90) after adjusting for ISS. Conclusions: The greater prevalence of NAT at vPTCs likely represents a more accurate measure of NAT among pediatric trauma patients, likely due to more experience and training of clinicians. Level of Evidence: Epidemiologic study, level III evidence. (C) 2017 Lippincott Williams & Wilkins, Inc.

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