title: Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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, 9th 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatric Critical Care, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Veerajalandhar
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: Department of Pediatric Critical Care, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Rahimullah
authors.initials: R
authors.lastname: Asad
authors.affiliation: Department of Dental Medicine, Harvard University, Boston, Massachusetts, United States of America.
authors.forename: Min Kyeong
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Department of Dental Medicine, Harvard University, Boston, Massachusetts, United States of America.
authors.forename: Romesh P
authors.initials: RP
authors.lastname: Nalliah
authors.affiliation: Department of Public Health, Texas A & M University, College Station, Texas, United States of America.
authors.forename: Sankeerth
authors.initials: S
authors.lastname: Rampa
authors.affiliation: Department of Pediatric Critical Care, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: David G
authors.initials: DG
authors.lastname: Speicher
authors.affiliation: Department of Pediatric Critical Care, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Alexandre T
authors.initials: AT
authors.lastname: Rotta
authors.affiliation: Department of Dentistry, University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Veerasathpurush
authors.initials: V
authors.lastname: Allareddy
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000401:mortality; D002673:Child, Hospitalized; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D014481:United States