Potential Opportunities for Prevention or Earlier Diagnosis of Child Physical Abuse in the Inpatient Setting
Date
2018
Journal Title
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Publisher
Hospital pediatrics
Abstract
OBJECTIVES: To compare rates of previous inpatient visits among children hospitalized with child
physical abuse (CPA) with controls as well as between individual abuse types.
METHODS: In this study, we used the Pediatric Health Information System administrative database
of 44 children’s hospitals. Children ,6 years of age hospitalized with CPA between January 1,
2011, and September 30, 2015, were identified by discharge codes and propensity matched to
accidental injury controls. Rates for previous visit types were calculated per 10 000 months of
life. x2 and Poisson regression were used to compare proportions and rates.
RESULTS: There were 5425 children hospitalized for CPA. Of abuse and accident cases, 13.1% and
13.2% had a previous inpatient visit, respectively. At previous visits, abused children had higher rates
of fractures (rate ratio [RR] 5 3.0 times; P 5 .018), head injuries (RR 5 3.5 times; P 5 .005),
symptoms concerning for occult abusive head trauma (AHT) (eg, isolated vomiting, seizures, brief
resolved unexplained events) (RR 5 1.4 times; P 5 .054), and perinatal conditions (eg, prematurity)
(RR 5 1.3 times; P 5 .014) compared with controls. Head injuries and symptoms concerning
for occult AHT also more frequently preceded cases of AHT compared with other types of abuse
(both P , .001).
CONCLUSIONS: Infants hospitalized with perinatal-related conditions, symptoms concerning for
occult AHT, and injuries are inpatient populations who may benefit from abuse prevention efforts
and/or risk assessments. Head injuries and symptoms concerning for occult AHT (eg, isolated
vomiting, seizures, and brief resolved unexplained events) may represent missed opportunities
to diagnose AHT in the inpatient setting; however, this requires further study.
Description
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Article
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Keywords
child abuse, abusive head trauma, physical abuse, research, hospital, statistics, revictimization
Citation
Puls, H. T., Anderst, J. D., Bettenhausen, J. L., Masonbrink, A., Markham, J. L., Plencner, L., ... & Hall, M. (2018). Potential opportunities for prevention or earlier diagnosis of child physical abuse in the inpatient setting. Hospital pediatrics, hpeds-2017.