title: The importance of surgeon involvement in the evaluation of non-accidental trauma patients.
abstract: BACKGROUND
  Non-Accidental Trauma (NAT) is a significant cause of childhood morbidity and mortality, causing 50% of trauma-related deaths at our institution. Our purpose was to evaluate the necessity of primary surgical evaluation and admission to the trauma service for children presenting with NAT.
  
  
  METHODS
  We reviewed all NAT patients from 2007-2011. Injury types, demographic data, and hospitalization information were collected. Comparisons to accidental trauma (AT) patients were made using Wilcoxon rank sum and Student's t tests.
  
  
  RESULTS
  We identified 267 NAT patients presenting with 473 acute injuries. Injuries in NAT patients were more severe than in AT patients, and Injury Severity Scores, ICU admission rates, and mortality were all significantly (p<0.001) higher. The majority suffered from polytrauma. Multiple areas of injury were seen in patients with closed head injuries (72%), extremity fractures (51%), rib fractures (82%), and abdominal/thoracic trauma (80%). Despite these complex injury patterns, only 56% received surgical consults, resulting in potential delays in diagnosis, as 24% of abdominal CT scans were obtained >12 hours after hospitalization.
  
  
  CONCLUSIONS
  Given the high incidence of polytrauma in NAT patients, prompt surgical evaluation is necessary to determine the scope of injury. Admission to the trauma service and a thorough tertiary survey should be considered for all patients.
authors.affiliation: Texas Children's Hospital Trauma Program, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Larimer
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.forename: Jaimee
authors.initials: J
authors.lastname: Westfall
authors.forename: Mary
authors.initials: M
authors.lastname: Frost
authors.forename: David E
authors.initials: DE
authors.lastname: Wesson
authors.forename: Bindi J
authors.initials: BJ
authors.lastname: Naik-Mathuria
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D010343:Patient Admission; D012042:Registries; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014194:Traumatology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*
keywords: Child Abuse; Non-accidental Trauma; Pediatrics