Consistent screening of admitted infants with head injuries reveals high rate of nonaccidental trauma

Infographic · Oct 2018 · 1 min read

In brief

Systematic screening of 563 infants admitted with unwitnessed head injuries identified nonaccidental trauma in 25.6% of cases, with skeletal survey showing 94% positive predictive value. Insurance status and injury severity were significant predictors of abuse, while race showed no correlation, supporting universal screening protocols.

25.6% of infants admitted with unwitnessed head injuries were victims of nonaccidental trauma, supporting routine screening protocols.
Skeletal survey demonstrated 94% positive predictive value for identifying nonaccidental trauma in screened infants.
Insurance status (public/none) and injury severity score predicted abuse risk; race showed no correlation in multivariate analysis.
Consistent screening eliminated disparities and identified one in four cases as intentional injury requiring child protection intervention.
Higher injury severity scores in NAT victims emphasize need for systematic evaluation to prevent future harm and missed diagnoses.

Written by the GCMD Library team from the infographic.

A teal-bordered infographic with a silhouette icon of an infant's head wearing a beanie at the top. The layout flows vertically with key statistics highlighted in larger text. Green text emphasizes a risk factor finding, and the Journal of Pediatric Surgery logo appears in the top right corner.

Purpose

Implementation of a nonaccidental trauma (NAT) screening guideline for the evaluation of infants admitted with an unwitnessed head injury has eliminated screening disparities. This study sought to determine the overall NAT rate and key predictive factors using this guideline.

Methods

All infants screened via the guideline from 2008 to 2015 were retrospectively reviewed. The overall rate of NAT as determined by our child abuse team was determined. In addition, a logistic regression model was developed to evaluate potential predictors of increased risk of NAT.

Results

A total of 563 infants were screened with an overall rate of NAT of 25.6% (n = 144). NAT screening was consistent across race and insurance status. By univariate analysis, patients with government insurance or no insurance had a significantly higher rate of NAT, but race was not a factor. Also NAT victims had significantly higher ISS. Skeletal survey showed high positive predictive value of 94%. When regression modeling was performed, ISS, abnormal skeletal survey and having public or no insurance were significantly correlated with NAT, while race showed no correlation.

Conclusion

One quarter of infants admitted with a head injury not witnessed in a public situation were identified as the victims of NAT. The high rate of abuse among this population supports routine screening in order to avoid missing intentional injuries and preventing future injuries. Race is not a predictor of NAT, but insurance status, as a proxy for socioeconomic status, is correlated, and further investigation is needed.

The text in the image

Consistent screening of admitted infants with head injuries reveals high rate of nonaccidental trauma | Paul T. Kim, Jillian McCagg, Ashley Dundon, Zach Ziesler, Suzanne Moody, Richard A. Falcone Jr. | Journal of Pediatric Surgery | Of 563 infants with non witnessed head injuries | 25% were non-accidental trauma | Pts with government or no insurance are at a higher risk | Skeletal survey has 94% PPV | visual abstract created by Abdulraouf Lamoshi

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