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. 2014 Jun 11;9(2):e100110.
doi: 10.1371/journal.pone.0100110. eCollection 2014.

Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality

Veerajalandhar Allareddy  1 , Rahimullah Asad  1 , Min Kyeong Lee  2 , Romesh P Nalliah  2 , Sankeerth Rampa  3 , David G Speicher  1 , Alexandre T Rotta  1 , Veerasathpurush Allareddy  4
Affiliations

Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality

Veerajalandhar Allareddy et al. PLoS One. .

Abstract

Objectives: To describe nationally representative outcomes of physical abuse injuries in children necessitating Emergency Department (ED) visits in United States. The impact of various injuries on mortality is examined. We hypothesize that physical abuse resulting in intracranial injuries are associated with worse outcome.

Materials and methods: We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS), the largest all payer hospital based ED database, for the years 2008-2010. All ED visits and subsequent hospitalizations with a diagnosis of "Child physical abuse" (Battered baby or child syndrome) due to various injuries were identified using ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes. In addition, we also examined the prevalence of sexual abuse in this cohort. A multivariable logistic regression model was used to examine the association between mortality and types of injuries after adjusting for a multitude of patient and hospital level factors.

Results: Of the 16897 ED visits that were attributed to child physical abuse, 5182 (30.7%) required hospitalization. Hospitalized children were younger than those released treated and released from the ED (1.9 years vs. 6.4 years). Male or female partner of the child's parent/guardian accounted for >45% of perpetrators. Common injuries in hospitalized children include- any fractures (63.5%), intracranial injuries (32.3%) and crushing/internal injuries (9.1%). Death occurred in 246 patients (13 in ED and 233 following hospitalization). Amongst the 16897 ED visits, 1.3% also had sexual abuse. Multivariable analyses revealed each 1 year increase in age was associated with a lower odds of mortality (OR = 0.88, 95% CI = 0.81-0.96, p < 0.0001). Females (OR = 2.39, 1.07-5.34, p = 0.03), those with intracranial injuries (OR = 65.24, 27.57-154.41, p<0.0001), or crushing/internal injury (OR = 4.98, 2.24-11.07, p<0.0001) had higher odds of mortality compared to their male counterparts.

Conclusions: In this large cohort of physically abused children, younger age, females and intracranial or crushing/internal injuries were independent predictors of mortality. Identification of high risk cohorts in the ED may enable strengthening of existing screening programs and optimization of outcomes.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The number of ED visits and the number of hospitalizations due to physical abuse decreased over the analyzed time period (2008 to 2010).
Figure 2
Figure 2. Common types of Injuries in Hospitalized Children.
Figure 3
Figure 3. Effect of age on ED visits and in-hospital mortality.
ED visits represented by left y axis and in-hospital mortality (%) by right y axis.
See this image and copyright information in PMC

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Grants and funding

The authors have no support or funding to report.