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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
"younger age"
symptom
child syndrome
dracunculiasis
von hippel-lindau disease
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