Information de reference pour ce titreAccession Number: | 01586154-201307000-00028.
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Author: | Deans, Katherine J. MD, MHSc; Thackeray, Jonathan MD; Askegard-Giesmann, Johanna R. MD; Earley, Elizabeth MPH; Groner, Jonathan I. MD; Minneci, Peter C. MD, MHSc
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Institution: | From the Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital (K.J.D., E.E., P.C.M.), and the Department of Surgery (K.J.D., J.R.A.-G., J.I.G., P.C.M.) and the Division of Child and Family Advocacy (K.J.D., J.T.), Nationwide Children's Hospital, Columbus, Ohio.
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Title: | |
Source: | Journal of Trauma and Acute Care Surgery. 75(1):161-165, July 2013.
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Abstract: | BACKGROUND: Nonaccidental trauma (NAT) is a leading cause of childhood traumatic injury and death. Our objectives were to compare the mortality rates of children who experience recurrent episodes of NAT (rNAT) with children who experience a single episode of NAT and to identify factors associated with rNAT and increased mortality from rNAT.
METHODS: Patients of NAT and rNAT in the Ohio State Trauma Registry were identified by matching date of birth, race, and sex between records of patients younger than 16 years between 2000 and 2010 with an DRG International Classification of Diseases-9th Rev. e-code for child abuse (E967-E967.9). Statistical comparisons were made using Fisher's exact and Wilcoxon rank-sum tests.
RESULTS: A total of 1,572 patients of NAT were identified, with 53 patients meeting criteria for rNAT. Compared with patients with single-episode NAT, patients with rNAT were more commonly male (66% vs. 52%, p = 0.05), were white (83% vs. 65%, p = 0.02), were evaluated at a pediatric trauma center (87% vs. 69%, p = 0.008), and had higher mortality (24.5% vs. 9.9%, p = 0.002). Compared with rNAT patients who did not die, those who died with rNAT had a longer interval from initial episode to second episode (median [interquartile range], 527 days [83-1,099] vs. 166 days [52-502]; p = 0.07) and were older during their second episode (1 year [<6 months to 3 years] vs. <6 months [<6 months to 1 year]; p = 0.06). At initial presentation, lower-extremity fractures (p = 0.09) and liver injuries (p = 0.06) were reported more commonly in nonsurvivors of rNAT.
CONCLUSION: Mortality is significantly higher in children who experience rNAT. Therefore, it is critically important to effectively intervene with appropriate resources and follow-up after a child's initial episode of NAT to prevent a future catastrophic episode.
LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level IV.
(C) 2013 Lippincott Williams & Wilkins, Inc.
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Author Keywords: | Recurrent nonaccidental trauma; recurrent abuse; children; mortality.
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Language: | English.
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Document Type: | EAST 2013 Poster Papers.
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ISSN: | 2163-0755
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DOI Number: | https://dx.doi.org/10.1097/TA.0b...- ouverture dans une nouvelle fenêtre
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