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- Title
Development of a systematic protocol to identify victims of non-accidental trauma.
- Authors
Escobar, Mauricio; Pflugeisen, Bethann; Duralde, Yolanda; Morris, Carolynn; Haferbecker, Dustin; Amoroso, Paul; Lemley, Hilare; Pohlson, Elizabeth; Escobar, Mauricio A Jr; Pflugeisen, Bethann M; Morris, Carolynn J; Amoroso, Paul J; Pohlson, Elizabeth C
- Abstract
<bold>Purpose: </bold>Each year, nearly 1 million children in the USA are victims of non-accidental trauma (NAT). Missed diagnosis or poor case management often leads to repeat/escalation injury. Victims of recurrent NAT are at higher risk for severe morbidity and mortality resulting from abuse. The objective of this review is to describe the evolution and implementation of this tool and evaluate our institutional response to NAT prior to implementation.<bold>Methods: </bold>A systematic guideline for the evaluation of pediatric patients in which NAT is suspected or confirmed was developed and implemented at a level II pediatric trauma hospital. To understand the state of our institution prior to implementation of the guideline, a review of 117 confirmed NAT cases at our hospital over the prior 4 years was conducted.<bold>Results: </bold>In the absence of a systematic management guideline, important and relevant social and family history red flags were often missing in the initial evaluation. Patients with perineal bruising experienced significantly higher mortality than patients without perineal bruising (27.3 vs. 5.7%; p = 0.03) and were significantly more likely to require surgery (45.5 vs. 14.2%; p = 0.02).<bold>Conclusion: </bold>Development and implementation of a standardized tool for the differentiation and diagnosis of NAT and creation of a structured electronic medical record note should improve the description and documentation of child abuse cases in a community hospital setting. A retrospective analysis demonstrated that in the absence of such a tool, management of NAT may be inconsistent or incomplete. Perineal injury is an especially ominous red flag finding.
- Subjects
SYSTEMATIC reviews; CHILD abuse; PEDIATRIC surgery; ELECTRONIC health records; COMORBIDITY; TRAUMATOLOGY diagnosis; PERINEUM; COMPARATIVE studies; BONE fractures; HEALTH status indicators; RESEARCH methodology; MEDICAL cooperation; MEDICAL history taking; MEDICAL protocols; RESEARCH; BRUISES; EVALUATION research; RETROSPECTIVE studies; TRAUMA severity indices; WOUNDS &; injuries
- Publication
Pediatric Surgery International, 2016, Vol 32, Issue 4, p377
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-016-3863-8