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. 2022 Jun 1;38(6):e1279-e1284.
doi: 10.1097/PEC.0000000000002724. Epub 2022 May 3.

Identification of Initial and Subsequent Injury in Young Infants: Opportunities for Quality Improvement in the Evaluation of Child Abuse

Jonathan D Thackeray  1 , Kristin G Crichton  2 , Paul McPherson  3 , Eugene Izsak  4 , Lori Vavul-Roediger  1 , Grace Kim  5 , Sandra Spencer  2 , Carrie Baker  6 , Emily A Eismann  7 , Robert A Shapiro  7 ; TRAIN Collaborative
Affiliations

Identification of Initial and Subsequent Injury in Young Infants: Opportunities for Quality Improvement in the Evaluation of Child Abuse

Jonathan D Thackeray et al. Pediatr Emerg Care. .

Abstract

Methods: Six children's hospitals identified infants with an initial injury and recurrent injury over a 1-year period using 2 methods: (1) diagnostic code method - infants 6 months or younger presenting with at least 1 diagnostic code for injury were tracked for 12 months to determine the frequency of recurrent injury, and (2) consult method - all available medical records of children 18 months or younger seen for an inpatient consultation for suspected child abuse were reviewed to identify history of a first injury at 6 months or younger.

Results: Using the diagnostic code method, 682 unique infants were identified with initial injuries, most commonly fractures (37.0%), bruising/ecchymosis (35.9%), and superficial injuries (28.3%). Forty-two infants (6.2%) returned with a second injury, and no demographic factors were significantly associated with the likelihood of a second injury. Using the consult method, 37 of 342 consults (10.8%) were identified as having a history of at least 1 initial injury. Of the initial injuries identified, the most common was bruising/ecchymosis (64.9%). The number of injuries identified with either method varied significantly across hospitals, as did completion of skeletal surveys for infants with bruising (range, 4.5%-71.1%; P < 0.001) and any injury (range, 4.4%-62.7%; P < 0.001).

Conclusions: Our study demonstrates that young infants who experience 1 injury often experience a second injury. There exists significant variability in the identification of injury and the completion of skeletal surveys across a network of 6 children's hospitals. A standardized quality improvement approach may improve identification of injury and reduce the variability in practice observed.

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Conflict of interest statement

Disclosure: The authors declare no conflict of interest.

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