Adverse outcomes in child abuse: a 7-year analysis of patients with traumatic brain injury.

Abstract

Objective: Child abuse is a critical public health issue that profoundly affects pediatric health and well-being. Child abuse patients who have sustained traumatic brain injuries (TBIs) present with a unique subset of injuries with complex medical and social implications. This study aims to explore the socioeconomic disparities, injury characteristics, and outcomes in child abuse patients who have sustained TBIs.

Methods: The authors conducted a retrospective review of their institutional emergency department (ED) database (June 2016-June 2023) to identify pediatric TBI cases (patient age ≤ 18 years) using ICD-10 codes based on a modified Centers for Disease Control and Prevention framework. Documented cases of child abuse, neglect, or inadequate supervision with investigations by a multidisciplinary child protection team were identified by reviewing the records of ED admissions. Patient demographics, zip codes, injury characteristics, and clinical outcomes were collected. The Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS), with higher ISSs and lower TRISSs indicating more severe injuries, respectively, were obtained. The Social Deprivation Index was used to assess neighborhood disadvantage, with higher scores indicating adverse health outcomes. Standard bivariate and multivariate regression analyses were performed.

Results: This study included 2954 patients with TBI, whose mean age was 7.05 ± 5.50 years; 36.6% of the patients were female and 40.4% were White. Among the overall cohort of TBI cases, 86.6% were non-child abuse cases, while 13.4% were child abuse cases. The child abuse cohort had a significantly lower average age (2.02 vs 7.83 years, p < 0.001) than the non-child abuse group. In multivariate regression models, child abuse patients had higher odds of being conveyed to the hospital via private transport (adjusted odds ratio [aOR] 2.201, p < 0.001); had higher odds of residing in a deprived neighborhood, as indicated by the SDI (aOR 1.009, p < 0.001); and had sustained more severe injuries on admission, as indicated by the ISS and TRISS (aOR 1.064, p < 0.001; aOR 0.970, p < 0.001, respectively). Child abuse patients had higher odds of a prolonged hospital stay (aOR 4.061, p < 0.001), a nonroutine discharge (aOR 6.186, p < 0.001), ED transfer to the intensive care unit (aOR 2.696, p < 0.001), and death on admission (aOR 3.131, p < 0.001).

Conclusions: This study highlights neighborhood disadvantage, more severe injuries, and adverse outcomes in child abuse-related TBI, emphasizing the need for targeted interventions to address socioeconomic disparities and improve healthcare for this vulnerable population.