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 injuriesrelated to maltreatment. The purpose of this study was to identify risk factors for repeated injuries in children withsuspected NAT. Methods: We conducted a retrospective cohort study using claims data from a pediatric Medicaid accountable careorganization. Children with birth claims and at least one non-birth related claim indicating a diagnosis of NAT or skeletalsurvey in 2007-2011 were included. Recurrent events were defined as independent episodes of care involving anurgent/emergent care setting that included a diagnosis code specific for child abuse, a CPT code for a skeletalsurvey, or a diagnosis code for an injury suspicious for abuse. Cox proportional hazards models were used toexamine risk factors for recurrent events. Results: Of the 1,361 children with suspected NAT, a recurrent NAT event occurred in 26% within 1 year and40% within 2 years of their initial event. Independent risk factors for a recurrent NAT event included a ruralresidence, age < 30 months old, having only 1 or 2 initially detected injuries, and having a dislocation, openwound, 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 oneyear. These children were younger and more likely to present with "minor" injuries at their previous event.