P3.052: Epidemiological Trends and Clinical Outcomes of Non-Accidental Trauma in Pediatric Patients: A Retrospective Analysis of the National Trauma Data Bank

Background: Non-accidental trauma (NAT) is a significant public health concern, contributing to severe morbidity and mortality in pediatric patients. NAT, commonly associated with child abuse, presents practitioners with the unique diagnostic challenge of differentiating it from unintentional injury. Understanding the epidemiology, injury patterns, and outcomes of NAT is critical for improving early detection, intervention strategies, and healthcare resource allocation. Previous literature has shown that NAT disproportionately affects younger children and leads to more severe injuries and longer hospital stays. However, recent data on post-COVID-19 trends remain limited. This study analyzes 2021–2023 National Trauma Data Bank (NTDB) pediatric trauma cases to assess NAT incidence, demographic disparities, and outcomes, providing updated insights to inform prevention and intervention efforts.

Methods: We retrospectively analyzed 393,062 pediatric (≤17 years) trauma cases from the NTDB (2021–2023). NAT cases were identified using ICD-10 codes and compared to unintentional trauma patients based on demographics, Injury Severity Score (ISS), hospital stay, ICU admissions, injury patterns, complications, polytrauma, mechanism of injury, and discharge disposition. Chi-square tests assessed significance. Injury patterns, complications, polytrauma, mechanisms of injury, and discharge dispositions were analyzed.

Results: Of 393,062 cases, 221 cases (approximately 0.06%) were identified as NAT. Compared to patients with accidental trauma, NAT victims were younger (mean age 4.78 vs. 9.88 years, p < 0.000001) and had different gender and racial distributions, with Black children comprising 42.99% of NAT cases vs. 18.62% in non-NAT cases. NAT cases had higher ISS (12.94 vs. 7.04) and longer hospital stays (8.97 vs. 4.78 days, p < 0.001). ICU admissions were significantly more frequent among NAT patients (chi‑square p = 0.0003). NAT patients exhibited significantly higher rates of severe head injuries (p = 0.0012) and traumatic brain injuries (p = 0.0020). Hospital complications—including infections, respiratory issues, and multi‑organ dysfunction—were significantly more common in the NAT group (p = 0.0005). Polytrauma cases were observed at a higher frequency among NAT patients (p = 0.0031). There were significant differences in injury mechanisms, with NAT injuries more frequently attributed to deliberate harm (p = 0.019), less often high-energy mechanisms (p = 0.008), and more often low-energy injuries like falls or (p = 0.031) and blunt trauma (p = 0.027) that were inconsistent with the reported injury severity. NAT patients were significantly more likely to be discharged to long‑term care or rehabilitation facilities rather than home (p = 0.0008). NAT incidence declined significantly from 95 cases in 2021 to 60 in 2023 (p = 0.004093), while mean age and ISS remained stable.

Conclusion: NAT disproportionately affects younger and Black children, with more severe injuries and poorer outcomes. Although incidence declined post-COVID, further research is needed to understand this trend.