Knowing Your Patient Population: Techniques to Capture Infants at High Risk for Physical Abuse in a Trauma Registry.

Authors

Stephanie Papillon, Department of Pediatric General, Thoracic and Minimally Invasive Surgery, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, 19134, USAFollow
Sahal Master, Department of Pediatric General, Thoracic and Minimally Invasive Surgery, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, 19134, USA
Matthew Klein
Allison Toth
Norrell Atkinson MD, Section of General Pediatrics, Child Protection Program, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, 19134, USA.Follow
Stephen Aronoff, Section of Pediatric Infectious Diseases, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, USA 19134.Follow
Harsh Grewal, Department of Pediatric General, Thoracic and Minimally Invasive Surgery, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, 19134, USA; Drexel University College of Medicine, 2900 W. Queen Lane, Philadelphia, PA, 19129, USA.Follow

Document Type

Article

Publication Date

2-8-2024

Abstract

BACKGROUND: Physical abuse is a major public health concern and a leading cause of morbidity and mortality in infants. Clinical decision tools derived from trauma registries can facilitate timely risk-stratification. The Trauma Quality Improvement Program (TQIP) database does not report age for childrenage.

METHODS: Patients ≤17 years were identified from TQIP (2017-2019). The primary outcomes included injuries resulting from confirmed or suspected child abuse captured by diagnosis codes or report/investigation of physical abuse, or different caregiver at discharge available in TQIP. We used two methods to select infants within TQIP. In the first, World Health Organization (WHO) growth standards for stature or length-for-age and weight-for-age were selected to capture children younger than 1 year. In the second, a K-means machine learning algorithm was used to cluster patients by weight and height. We compared outcome and injury data with and without patients <1 >year.

RESULTS: Using the WHO growth standard 19,916 children20,513 patients had a report of physical abuse filed, and 9393 were infants[95% CI] were seen for fractures of the upper limb (1.28 [1.22-1.34]), vertebrae (1.89 [1.68-2.13]), ribs (5.2 [4.8-5.63]), and spinal cord (3.39 [2.85-4.02]) and head injuries (1.55 [1.5-1.6]) with infants included.

CONCLUSIONS: In a nationwide trauma registry, WHO growth standards can be used to capture patients under one year who are more adversely impacted by maltreatment.

TYPE OF STUDY: Retrospective, Cross-sectional.

LEVEL OF EVIDENCE: Level III, Diagnostic.

Publication Title

Journal of pediatric surgery

Comments

Online ahead of print

Recommended Citation

Papillon, S., Master, S., Klein, M., Toth, A., Atkinson, N., Aronoff, S., & Grewal, H. (2024). Knowing Your Patient Population: Techniques to Capture Infants at High Risk for Physical Abuse in a Trauma Registry.. Journal of pediatric surgery https://doi.org/https://doi.org/10.1016/j.jpedsurg.2024.02.004