Objectives & Background Non-accidental injury in children is generally understood to have a different injury and age profile from accidental injury. The Trauma Audit Research Network (TARN) in the UK recently compared the demographics of paediatric versus adult trauma. This paper compares accidental with non-accidental major injury in children.

Methods The national trauma registry of England and Wales – Trauma Audit and Research Network (TARN) database was interrogated for the classification of mechanism of injury in children by intent, from January 2004 to December 2013. Contributing hospitals' data was classified into accidental injury (AI), suspected child abuse (SCA) or alleged assault (AA) to enable demographic and injury comparisons.

Results In the study population of 14,821 children, 13,695 (92.4%) were classified as accidental injury, 368 as alleged assault (2.5%) and 758 as suspected child abuse (5.1%). Nearly all cases of severely injured children suffering trauma because of suspected child abuse occurred in the 0-5 year old age group (740 of 758, 97.6%). Of all suspected abuse cases, 584 of 758 (77%) occurred in babies under the age of one year. Compared with accidental injury, abused children have higher injury severity scores, particularly as a result of head injury and a three-fold higher mortality rate.

Conclusion This study highlights that major injury occurring as a result of child abuse has a typical demographic pattern. Abused children tend to be under 12 months of age, with more severe injury, especially head injury. Understanding the demographics of this patient group could help receiving hospitals identify children with major injuries resulting from abuse, and ensure swift transfer to specialist care.