Major Trauma from Suspected Child Abuse patient journey revised clean copy.pdf (965.89 kB)
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Major trauma from suspected child abuse: a profile of the patient pathway

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journal contribution
posted on 01.07.2020, 12:44 by Ffion C Davies, Fiona E Lecky, Ross Fisher, Marisol Fragoso-Iiguez, Tim J Coats
Background Networked organised systems of care for patients with major trauma now exist in many countries, designed around the needs of the majority of patients (90% adults). Non-accidental injury is a significant cause of paediatric major trauma and has a different injury and age profile from accidental injury (AI). This paper compares the prehospital and inhospital phases of the patient pathway for children with suspected abuse, with those accidentally injured. Methods The paediatric database of the national trauma registry of England and Wales, Trauma Audit and Research Network, was interrogated from April 2012 (the launch of the major trauma networks) to June 2015, comparing the patient pathway for cases of suspected child abuse (SCA) with AI. Results In the study population of 7825 children, 7344 (94%) were classified as AI and 481 (6%) as SCA. SCA cases were younger (median 0.4 years vs 7 years for AI), had a higher Injury Severity Score (median 16vs9 for AI), and had nearly three times higher mortality (5.7%vs2.2% for AI). Other differences included presentation to hospital evenly throughout the day and year, arrival by non-ambulance means to hospital (74%) and delayed presentation to hospital from the time of injury (median 8 hours vs 1.8 hours for AI). Despite more severe injuries, these infants were less likely to receive key interventions in a timely manner. Only 20% arrived to a designated paediatric-capable major trauma centre. Secondary transfer to specialist care, if needed, took a median of 21.6 hours from injury(vs 13.8 hours for AI). Conclusion These data show that children with major trauma that is inflicted rather than accidental follow a different pathway through the trauma system. The current model of major trauma care is not a good fit for the way in which child victims of suspected abuse present to healthcare. To achieve better care, awareness of this patient profile needs to increase, and trauma networks should adjust their conventional responses.

History

Citation

Emergency Medicine Journal 2017;34:562-567

Author affiliation

Leicester Royal Infirmary

Version

AM (Accepted Manuscript)

Published in

EMERGENCY MEDICINE JOURNAL

Volume

34

Issue

9

Pagination

562 - 567

Publisher

BMJ PUBLISHING GROUP

issn

1472-0205

eissn

1472-0213

Acceptance date

12/01/2017

Copyright date

2017

Available date

24/04/2017

Spatial coverage

England

Language

English

Publisher version

https://emj.bmj.com/content/34/9/562