title: A profile of suspected child abuse as a subgroup of major trauma patients.
abstract: BACKGROUND
  Non-accidental injury (NAI) in children is an important cause of major injury. The Trauma Audit Research Network (TARN) recently analysed data on the demographics of paediatric trauma and highlighted NAI as a major cause of death and severe injury in children. This paper examined TARN data to characterise accidental versus abusive cases of major injury.
  
  
  METHODS
  The national trauma registry of England and Wales (TARN) database was interrogated for the classification of mechanism of injury in children by intent, from January 2004 to December 2013. Contributing hospitals' submissions were classified into accidental injury (AI), suspected child abuse (SCA) or alleged assault (AA) to enable demographic and injury comparisons.
  
  
  RESULTS
  In the study population of 14 845 children, 13 708 (92.3%, CI 91.9% to 92.8%) were classified as accidental injury, 368 as alleged assault (2.5%, CI 2.2% to 2.7%) and 769 as SCA (5.2%, CI 4.8% to 5.5%). Nearly all cases of severely injured children suffering trauma because of SCA occurred in the age group of 0-5 years (751 of 769, 97.7%), with 76.3% occurring in infants under the age of 1 year. Compared with accidental injury, suspected victims of abuse have higher overall injury severity scores, have a higher proportion of head injury and a threefold higher mortality rate of 7.6% (CI 5.51% to 9.68%) vs 2.6% (CI 2.3% to 2.9%).
  
  
  CONCLUSIONS
  This study highlights that major injury occurring as a result of SCA has a typical demographic pattern. These children tend to be under 12 months of age, with more severe injury. Understanding these demographics could help receiving hospitals identify children with major injuries resulting from abuse and ensure swift transfer to specialist care.
authors.affiliation: Emergency Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Ffion C
authors.initials: FC
authors.lastname: Davies
authors.affiliation: Department of Emergency Medicine, University of Leicester, Leicester, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coats
authors.affiliation: Department of Surgery, Sheffield Children's Hospital, Sheffield, UK.
authors.forename: Ross
authors.initials: R
authors.lastname: Fisher
authors.affiliation: Trauma Audit Research Network, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lawrence
authors.affiliation: Health Services Research, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lecky
mesh_terms: D017677:Age Distribution; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000401:mortality; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis; D014852:Wales / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality
keywords: Trauma; major trauma management; paediatric emergency med; paediatric injury; paediatrics, non accidental injury