title: Risk factors for recurrent injuries in victims of suspected non-accidental trauma: a retrospective cohort study.
abstract: BACKGROUND
  Many children who are victims of non-accidental trauma (NAT) may be repeatedly evaluated for injuries related to maltreatment. The purpose of this study was to identify risk factors for repeated injuries in children with suspected NAT.
  
  
  METHODS
  We conducted a retrospective cohort study using claims data from a pediatric Medicaid accountable care organization. Children with birth claims and at least one non-birth related claim indicating a diagnosis of NAT or skeletal survey in 2007-2011 were included. Recurrent events were defined as independent episodes of care involving an urgent/emergent care setting that included a diagnosis code specific for child abuse, a CPT code for a skeletal survey, or a diagnosis code for an injury suspicious for abuse. Cox proportional hazards models were used to examine risk factors for recurrent events.
  
  
  RESULTS
  Of the 1,361 children with suspected NAT, a recurrent NAT event occurred in 26% within 1 year and 40% within 2 years of their initial event. Independent risk factors for a recurrent NAT event included a rural residence, age < 30 months old, having only 1 or 2 initially detected injuries, and having a dislocation, open wound, or superficial injury at the previous event (p ≤ 0.01 for all).
  
  
  CONCLUSIONS
  Over 25% of children who experienced a suspected NAT event had a recurrent episode within one year. These children were younger and more likely to present with "minor" injuries at their previous event.
authors.affiliation: Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, 700 Childrens Drive, JWest - 4th floor, Columbus, OH 43205, USA. katherine.deans@nationwidechildrens.org.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.forename: Jonathan
authors.initials: J
authors.lastname: Thackeray
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Groner
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
mesh_terms: D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008484:Medicaid; D009820:Ohio / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology*