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Prevalence of nonaccidental trauma among children at American College of Surgeons–verified pediatric trauma centers

Bogumil, David D.A. MPH; Demeter, Natalie E. MPH; Kay Imagawa, Karen MD; Upperman, Jeffrey S. MD; Burke, Rita V. PhD, MPH

Journal of Trauma and Acute Care Surgery: November 2017 - Volume 83 - Issue 5 - p 862–866
doi: 10.1097/TA.0000000000001629
Original Articles

BACKGROUND Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting. Extreme cases of child abuse, or nonaccidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians who 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 because of this additional experience and training 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 Prognostic/Epidemiological, Level II.

From the Division of Pediatric Surgery (D.D.A.B., N.E.D., J.S.U., R.V.B.), Children’s Hospital Los Angeles, Los Angeles, California; Department of Pediatrics and Audrey Hepburn Child Advocacy, Response and Evaluation Services Center (K.K.I.), Children’s Hospital Los Angeles, Los Angeles, California; and Keck School of Medicine (J.S.U., R.V.B., K.K.I), University of Southern California, Los Angeles, California.

Submitted: November 16, 2016, Revised: May 16, 2017, Accepted: May 19, 2017, Published online: June 19, 2017.

This study was presented at the 3rd annual Pediatric Trauma Society Meeting, November 11–12, 2016, in Nashville, Tennessee.

Address for reprints: Rita V. Burke, PhD, MPH, 4650 Sunset Blvd MS #100, Los Angeles, CA 90027; email:

© 2017 Lippincott Williams & Wilkins, Inc.