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NON-ACCIDENTAL INJURY: AN IMPORTANT CAUSE OF PAEDIATRIC MAJOR TRAUMA
  1. N Parry,
  2. L Goldsworthy,
  3. S Melsom,
  4. J Fryer,
  5. G Haythornthwaite
  1. Children's Emergency Department, Bristol Royal Hospital for Children, Bristol, UK

Abstract

Objectives & Background To establish the number of major trauma patients attending Bristol Royal Hospital for Children's Emergency Department with child protection concerns and suspected non- accidental injury (NAI). To identify the difference in injury patterns of children with suspected NAI versus accidentally injured children. NAI is an important cause of paediatric major trauma. There is a lack of research on NAI as a cause for paediatric major trauma. Results from national Trauma Audit & Research Network (TARN) data suggest that children with NAI have increased Injury Severity (ISS) and a higher mortality rate. According to TARN data in 2012, 10.1% of children with major trauma were <2 years old with NAI.

Methods All paediatric major trauma patients from 27/04/14- 26/12/14 were included. Electronic case-notes were reviewed. Information collected included: Injury Severity Score; mechanism of injury; injuries sustained; child protection documentation; imaging; disposal and outcome.

Results 122 Paediatric major trauma patients presented to ED and were included. 40 patients were secondary transfers. There was a weak positively skewed relationship between age and ISS. Mechanisms of injury were diverse. Commonest accidental injuries sustained were head, limb and abdominal/pelvic injuries. Child protection concerns were raised in 31 of the cases. 13 of these children had suspected NAI. Of these, there were 9 isolated injuries that included: 7 head injuries, 1 rectal perforation and 1 perineal tear. The remainder of cases involved severe multi-system trauma: 2 head injuries, 1 abdominal injury, 2 limb injuries, 3 chest injuries and 1 spinal injury. Non-ambulant children underwent the greatest proportion of CT heads compared to older children. 7/9 children in the suspected NAI group with head injuries were under 1-year-old. 9% all children were <2 years old with suspected NAI. Community Paediatricians were involved all suspected NAI cases.

Conclusion The findings of this study support previous TARN data, which suggests that NAI is a common cause of major trauma. Injury patterns are different in this group compared to accidental injury with increased proportion of head injuries, especially amongst the non-ambulant children.

  • Trauma

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