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The prevalence of non-accidental trauma among children with polytrauma : A nationwide level-I trauma centre study. / RAFIKI study group.

In: Journal of forensic and legal medicine, Vol. 90, 102386, 01.08.2022.

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RAFIKI study group. / The prevalence of non-accidental trauma among children with polytrauma : A nationwide level-I trauma centre study. In: Journal of forensic and legal medicine. 2022 ; Vol. 90.

BibTeX

@article{31f54f2e6ee54015b24b8c23c838b1e9,
title = "The prevalence of non-accidental trauma among children with polytrauma: A nationwide level-I trauma centre study",
abstract = "Objective: We aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC). Summary of background: Data 6–10% Of children who present at the emergency department with injuries, sustain polytrauma. Polytrauma may result from either accidental (AT) or NAT, i.e. inflicted or neglect. The prevalence of NAT among children with polytrauma is currently unclear. Methods: This is a retrospective study that included children (0–18 years) with an Injury Severity Score >15, who presented at one of the 11 Level-I trauma centers (TC) in the Netherlands between January 1, 2010 and January 1, 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect-team. Cases in which conclusions were unavailable and there was no clear accidental cause of injuries were reviewed by an expert panel. Results: The study included 1623 children, 1452 (89%) were classified as AT, 171 (11%) as NAT; 39 (2,4%) inflicted and 132 (8,1%) neglect. Of pre-school aged children (<5 years) 41% sustained NAT (OR26.73, 95%CI 17.70–40.35), 35/342 (10%) inflicted and 104/342 (31%) neglect. Admission due to {\textquoteleft}cardiopulmonary arrest{\textquoteright} was the result of inflicted trauma (30% vs 0%,p < 0.001). NAT had a higher mortality rate (16% vs 10%, p = 0.006). Indicators of NAT were: (near-)drowning (OR10.74, 95%CI 5.94–19.41), burn (OR8.62, 95%CI 4.08–18.19) and fall from height (OR2.18, 95%CI 1.56–3.02). Conclusions: NAT was the cause of polytrauma in 11% of children in our nationwide level-I TC study; 41% of these polytrauma were the result of NAT experienced by preschool-aged children. Our data show the importance of awareness for NAT.",
keywords = "Accidental, Child abuse, Neglect, Non-accidental, Pediatric trauma, Polytrauma",
author = "Loos, {Marie-Louise H. J.} and {van Rijn}, {Rick R.} and Egbert Krug and Bloemers, {Frank W.} and {ten Bosch}, {Jan A.} and Bossuyt, {P. M. M.} and Edwards, {Michael J. R.} and Greeven, {Alexander P. A.} and Hulscher, {Jan B. F.} and Keyzer-Dekker, {Claudia M. G.} and {de Ridder}, {Victor A.} and Spanjersberg, {W. Richard} and Teeuw, {Arianne H.} and Theeuwes, {Hilco P.} and {de Vries}, Selena and {de Wit}, Ralph and Roel Bakx and {de Boer}, Anne and Esther Edelenbos and Goslings, {J. Carel} and {van Sommeren}, {Lia P. G. W.} and Annelies Toor and Marjo Affourtit and {van Ditshuizen}, {Jan C.} and Wijnen, {Rene M. H.} and Kempink, {Dagmar R. J.} and Bessems, {Johannes H. JM.} and Tjebbe Hagenaars and {den Hartog}, Dennis and Jansen, {M. A. C.} and Allema, {J. H.} and Kanters, {Floris E. P.} and Annemieke Aalbers-Hiemstra and Arnaud Mulder and Frans Smiers and Hartendorf, {Rina C.} and Fiddelers, {Audrey A. A.} and Birgit Levelink and Martijn Poeze and {de Blaauw}, Ivo and Tromp, {Tjarda N.} and Benn Beuker and Inge Reininga and Klaus Wendt and Aspers-Wolters, {Stasja J. G.} and {RAFIKI study group} and {van de Putte}, {Elise M.}",
note = "Funding Information: This work was supported by the Louise Vehmeijer foundation [funding reference number 2016-007V ] the Netherlands. Funding Information: Secondly, as Davies et al. wrote, trauma networks need to adapt their response in order to improve patient outcomes.6 It is important to identify NAT as soon as possible, in order to ensure the safety of children during and after admission. Failure to recognize NAT can result in future injuries and death.6,33 The Advanced Trauma Life Support protocol{\textregistered} and the Advanced Pediatric Life Support protocol{\textregistered}34 are used at the ED, where the primary survey focuses on life-saving treatment during the {\textquoteleft}golden hour{\textquoteright}. During the secondary- but certainly during the tertiary survey, doctors need to pay attention to NAT as a cause of polytrauma. Recognizing NAT at hospitals creates a window of opportunity to intervene. An intervention can stop continuous abuse and possible interrupt the circle of violence. Hoytema et al. showed a positive impact of interventions after ED admission.35 In order to improve the detection of NAT, we believe that the determined indicators in our study should be further analysed. It may be possible to design a predication model for NAT to be used during secondary survey or tertiary survey in combination with clinical history.This work was supported by the Louise Vehmeijer foundation [funding reference number 2016-007V] the Netherlands. Publisher Copyright: {\textcopyright} 2022",
year = "2022",
month = aug,
day = "1",
doi = "10.1016/j.jflm.2022.102386",
language = "English",
volume = "90",
journal = "Journal of forensic and legal medicine",
issn = "1752-928X",
publisher = "Churchill Livingstone",

}

RIS

TY - JOUR

T1 - The prevalence of non-accidental trauma among children with polytrauma

T2 - A nationwide level-I trauma centre study

AU - Loos, Marie-Louise H. J.

AU - van Rijn, Rick R.

AU - Krug, Egbert

AU - Bloemers, Frank W.

AU - ten Bosch, Jan A.

AU - Bossuyt, P. M. M.

AU - Edwards, Michael J. R.

AU - Greeven, Alexander P. A.

AU - Hulscher, Jan B. F.

AU - Keyzer-Dekker, Claudia M. G.

AU - de Ridder, Victor A.

AU - Spanjersberg, W. Richard

AU - Teeuw, Arianne H.

AU - Theeuwes, Hilco P.

AU - de Vries, Selena

AU - de Wit, Ralph

AU - Bakx, Roel

AU - de Boer, Anne

AU - Edelenbos, Esther

AU - Goslings, J. Carel

AU - van Sommeren, Lia P. G. W.

AU - Toor, Annelies

AU - Affourtit, Marjo

AU - van Ditshuizen, Jan C.

AU - Wijnen, Rene M. H.

AU - Kempink, Dagmar R. J.

AU - Bessems, Johannes H. JM.

AU - Hagenaars, Tjebbe

AU - den Hartog, Dennis

AU - Jansen, M. A. C.

AU - Allema, J. H.

AU - Kanters, Floris E. P.

AU - Aalbers-Hiemstra, Annemieke

AU - Mulder, Arnaud

AU - Smiers, Frans

AU - Hartendorf, Rina C.

AU - Fiddelers, Audrey A. A.

AU - Levelink, Birgit

AU - Poeze, Martijn

AU - de Blaauw, Ivo

AU - Tromp, Tjarda N.

AU - Beuker, Benn

AU - Reininga, Inge

AU - Wendt, Klaus

AU - Aspers-Wolters, Stasja J. G.

AU - RAFIKI study group

AU - van de Putte, Elise M.

N1 - Funding Information: This work was supported by the Louise Vehmeijer foundation [funding reference number 2016-007V ] the Netherlands. Funding Information: Secondly, as Davies et al. wrote, trauma networks need to adapt their response in order to improve patient outcomes.6 It is important to identify NAT as soon as possible, in order to ensure the safety of children during and after admission. Failure to recognize NAT can result in future injuries and death.6,33 The Advanced Trauma Life Support protocol® and the Advanced Pediatric Life Support protocol®34 are used at the ED, where the primary survey focuses on life-saving treatment during the ‘golden hour’. During the secondary- but certainly during the tertiary survey, doctors need to pay attention to NAT as a cause of polytrauma. Recognizing NAT at hospitals creates a window of opportunity to intervene. An intervention can stop continuous abuse and possible interrupt the circle of violence. Hoytema et al. showed a positive impact of interventions after ED admission.35 In order to improve the detection of NAT, we believe that the determined indicators in our study should be further analysed. It may be possible to design a predication model for NAT to be used during secondary survey or tertiary survey in combination with clinical history.This work was supported by the Louise Vehmeijer foundation [funding reference number 2016-007V] the Netherlands. Publisher Copyright: © 2022

PY - 2022/8/1

Y1 - 2022/8/1

N2 - Objective: We aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC). Summary of background: Data 6–10% Of children who present at the emergency department with injuries, sustain polytrauma. Polytrauma may result from either accidental (AT) or NAT, i.e. inflicted or neglect. The prevalence of NAT among children with polytrauma is currently unclear. Methods: This is a retrospective study that included children (0–18 years) with an Injury Severity Score >15, who presented at one of the 11 Level-I trauma centers (TC) in the Netherlands between January 1, 2010 and January 1, 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect-team. Cases in which conclusions were unavailable and there was no clear accidental cause of injuries were reviewed by an expert panel. Results: The study included 1623 children, 1452 (89%) were classified as AT, 171 (11%) as NAT; 39 (2,4%) inflicted and 132 (8,1%) neglect. Of pre-school aged children (<5 years) 41% sustained NAT (OR26.73, 95%CI 17.70–40.35), 35/342 (10%) inflicted and 104/342 (31%) neglect. Admission due to ‘cardiopulmonary arrest’ was the result of inflicted trauma (30% vs 0%,p < 0.001). NAT had a higher mortality rate (16% vs 10%, p = 0.006). Indicators of NAT were: (near-)drowning (OR10.74, 95%CI 5.94–19.41), burn (OR8.62, 95%CI 4.08–18.19) and fall from height (OR2.18, 95%CI 1.56–3.02). Conclusions: NAT was the cause of polytrauma in 11% of children in our nationwide level-I TC study; 41% of these polytrauma were the result of NAT experienced by preschool-aged children. Our data show the importance of awareness for NAT.

AB - Objective: We aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC). Summary of background: Data 6–10% Of children who present at the emergency department with injuries, sustain polytrauma. Polytrauma may result from either accidental (AT) or NAT, i.e. inflicted or neglect. The prevalence of NAT among children with polytrauma is currently unclear. Methods: This is a retrospective study that included children (0–18 years) with an Injury Severity Score >15, who presented at one of the 11 Level-I trauma centers (TC) in the Netherlands between January 1, 2010 and January 1, 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect-team. Cases in which conclusions were unavailable and there was no clear accidental cause of injuries were reviewed by an expert panel. Results: The study included 1623 children, 1452 (89%) were classified as AT, 171 (11%) as NAT; 39 (2,4%) inflicted and 132 (8,1%) neglect. Of pre-school aged children (<5 years) 41% sustained NAT (OR26.73, 95%CI 17.70–40.35), 35/342 (10%) inflicted and 104/342 (31%) neglect. Admission due to ‘cardiopulmonary arrest’ was the result of inflicted trauma (30% vs 0%,p < 0.001). NAT had a higher mortality rate (16% vs 10%, p = 0.006). Indicators of NAT were: (near-)drowning (OR10.74, 95%CI 5.94–19.41), burn (OR8.62, 95%CI 4.08–18.19) and fall from height (OR2.18, 95%CI 1.56–3.02). Conclusions: NAT was the cause of polytrauma in 11% of children in our nationwide level-I TC study; 41% of these polytrauma were the result of NAT experienced by preschool-aged children. Our data show the importance of awareness for NAT.

KW - Accidental

KW - Child abuse

KW - Neglect

KW - Non-accidental

KW - Pediatric trauma

KW - Polytrauma

UR - http://www.scopus.com/inward/record.url?scp=85133588841&partnerID=8YFLogxK

U2 - 10.1016/j.jflm.2022.102386

DO - 10.1016/j.jflm.2022.102386

M3 - Article

C2 - 35839691

VL - 90

JO - Journal of forensic and legal medicine

JF - Journal of forensic and legal medicine

SN - 1752-928X

M1 - 102386

ER -

ID: 24983194