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

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 associ...

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Main Authors: Veerajalandhar Allareddy, Rahimullah Asad, Min Kyeong Lee, Romesh P Nalliah, Sankeerth Rampa, David G Speicher, Alexandre T Rotta, Veerasathpurush Allareddy
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2014-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC4053408?pdf=render
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spelling doaj-76f7ed9a40fe4e518e7898c7d10f663a2020-11-24T21:50:38ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0192e10011010.1371/journal.pone.0100110Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.Veerajalandhar AllareddyRahimullah AsadMin Kyeong LeeRomesh P NalliahSankeerth RampaDavid G SpeicherAlexandre T RottaVeerasathpurush AllareddyOBJECTIVES: 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.http://europepmc.org/articles/PMC4053408?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Veerajalandhar Allareddy
Rahimullah Asad
Min Kyeong Lee
Romesh P Nalliah
Sankeerth Rampa
David G Speicher
Alexandre T Rotta
Veerasathpurush Allareddy
spellingShingle Veerajalandhar Allareddy
Rahimullah Asad
Min Kyeong Lee
Romesh P Nalliah
Sankeerth Rampa
David G Speicher
Alexandre T Rotta
Veerasathpurush Allareddy
Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.
PLoS ONE
author_facet Veerajalandhar Allareddy
Rahimullah Asad
Min Kyeong Lee
Romesh P Nalliah
Sankeerth Rampa
David G Speicher
Alexandre T Rotta
Veerasathpurush Allareddy
author_sort Veerajalandhar Allareddy
title Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.
title_short Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.
title_full Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.
title_fullStr Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.
title_full_unstemmed Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.
title_sort hospital based emergency department visits attributed to child physical abuse in united states: predictors of in-hospital mortality.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2014-01-01
description 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.
url http://europepmc.org/articles/PMC4053408?pdf=render
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