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Major trauma from suspected child abuse: a profile of the patient pathway
  1. Ffion C Davies1,
  2. Fiona E Lecky2,
  3. Ross Fisher3,
  4. Marisol Fragoso-Iiguez4,
  5. Tim J Coats5
  1. 1 University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
  2. 2 Health Services Research, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  3. 3 Sheffield Children's Hospital, Sheffield, UK
  4. 4 Trauma Audit and Research Network, Salford Royal NHS Foundation Trust, Salford, UK
  5. 5 University of Leicester, Leicester, UK
  1. Correspondence to Dr Ffion C Davies, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK; Ffion.davies{at}uhl-tr.nhs.uk

Abstract

Background Networked organised systems of care for patients with major trauma now exist in many countries, designed around the needs of the majority of patients (90% adults). Non-accidental injury is a significant cause of paediatric major trauma and has a different injury and age profile from accidental injury (AI). This paper compares the prehospital and inhospital phases of the patient pathway for children with suspected abuse, with those accidentally injured.

Methods The paediatric database of the national trauma registry of England and Wales, Trauma Audit and Research Network, was interrogated from April 2012 (the launch of the major trauma networks) to June 2015, comparing the patient pathway for cases of suspected child abuse (SCA) with AI.

Results In the study population of 7825 children, 7344 (94%) were classified as AI and 481 (6%) as SCA. SCA cases were younger (median 0.4 years vs 7 years for AI), had a higher Injury Severity Score (median 16vs9 for AI), and had nearly three times higher mortality (5.7%vs2.2% for AI). Other differences included presentation to hospital evenly throughout the day and year, arrival by non-ambulance means to hospital (74%) and delayed presentation to hospital from the time of injury (median 8 hours vs 1.8 hours for AI). Despite more severe injuries, these infants were less likely to receive key interventions in a timely manner. Only 20% arrived to a designated paediatric-capable major trauma centre. Secondary transfer to specialist care, if needed, took a median of 21.6 hours from injury(vs 13.8 hours for AI).

Conclusion These data show that children with major trauma that is inflicted rather than accidental follow a different pathway through the trauma system. The current model of major trauma care is not a good fit for the way in which child victims of suspected abuse present to healthcare. To achieve better care, awareness of this patient profile needs to increase, and trauma networks should adjust their conventional responses.

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Footnotes

  • Contributors All authors contributed substantially to this paper. The main author for correspondence, FCD, was the main writer of the text and had the original idea to investigate this topic. FEL, TJC and RF helped with the writing and structure of the paper. MF-I supplied and helped analyse the data.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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