Outcomes of children hospitalized for abusive vs. non-inflicted abdominal trauma

Background/Purpose: Abusive abdominal trauma (AAT) is the 2nd leading cause of child abuse mortality. It is unclear whether the etiology of abdominal injury influences short term outcomes.

Methods: Abdominal trauma hospitalizations were identified from the Kid's Inpatient Database (KID) using ICD-9CM codes. Child abuse etiology was determined by ICD-9CM and E-codes. Length of hospitalization, mortality, and total charges were compared for children with AAT vs. Non-inflicted abdominal trauma (NIAT). Confounding variables were identified and included in logistic regression analyses. Severity of injury was controlled in multivariate analyses.

Results: Approximately 16 per million children <3 years were hospitalized for AAT in 2003. Children with AAT were younger (median age 1 vs. 6 years, p<0.01), and more often minority (36% vs. 16% African-American; 35% vs. 21% Hispanic; p<0.01) and poor (37% vs. 27% in lowest income quartile; p<0.01) compared to those with NIAT. In bivariate analyses, children with AAT had higher mortality (10% vs. 3%, p<0.01), longer hospitalizations (median 6 vs. 4 days; p<0.01), and higher median hospital charges ($31,150 vs. $15,422; p<0.01) compared to NIAT. On multivariate analysis, children with AAT had 2.5 times the odds of death (95% CI 1.1-6.2; p=0.04) and were 2.5 times more likely to be hospitalized for > 4 days, compared to children with NIAT. No differences in total charges by injury etiology were noted.

Conclusions: Children with abusive abdominal injuries have poorer short term outcomes compared to those with non-inflicted injury. Efforts to prevent AAT could benefit individual children and families, as well as society.