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Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.
[child syndrome]
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
.
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
,
9
th
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
.
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
.
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
.
Diseases
Validation
Diseases presenting
"large cohort"
symptom
adrenal incidentaloma
adrenomyeloneuropathy
cadasil
child syndrome
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
inclusion body myositis
junctional epidermolysis bullosa
kabuki syndrome
krabbe disease
oligodontia
pendred syndrome
phenylketonuria
thoracic outlet syndrome
waldenström macroglobulinemia
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