title: Beyond morbidity and mortality: the social and legal outcomes of non-accidental trauma.
abstract: BACKGROUND
  Abusive head trauma (AHT) is a significant cause of morbidity and mortality in the pediatric population. We aimed to assess the social and legal outcomes of AHT and determine if the rates of successful prosecution have changed over recent years.
  
  
  METHODS
  We utilized the trauma database at a single institution to identify all cases of AHT during two time periods: 1996-2001 and 2006-2010 then collected data from the Child Advocacy and Protection Team database. We characterized the social and legal outcomes and compared them between the two cohorts.
  
  
  RESULTS
  A total of 254 patients (120 historic and 134 modern cohort) were included. Mortality rate was 19.7% and did not differ between the two cohorts. Thirty-seven percent of patients were discharged to foster care, this rate did not change across the two time periods. Suspected perpetrators pled guilty or were found guilty in only 74 cases (29%). However, when a case involved a fatality, perpetrators pled or were found guilty more often than in cases of a non-fatality (50 vs. 21.5%; p=0.0001).
  
  
  CONCLUSIONS
  AHT results in fatality in approximately 1 in 5 cases, perpetrators are identified and found guilty in only 29% of the cases. Trauma surgeons need to be strong advocates for these vulnerable patients and actively participate in legal proceedings.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: shannon.acker@ucdenver.edu.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Roach
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Karrer
authors.affiliation: Department of Surgery, Denver Health Medical Center, Denver, CO, USA.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
authors.affiliation: Kempe Child Protection Team, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Sirotnak
mesh_terms: D002649:Child Abuse / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D002651:Child Advocacy / Q000331:legislation & jurisprudence*; D003120:Colorado / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Child abuse; Head injury; Outcomes; Pediatric; Trauma