Characteristics of non-accidental injuries in children and adolescents in Asia: a cross-national, multicenter cohort study

Abstract

Children and adolescents are vulnerable to non-accidental injury. Early identification and prevention rely on detailed epidemiological studies, which are limited in Asia. This retrospective study used the registry data of Pan-Asian Trauma Outcome Study (PATOS) from October 1, 2015 to December, 31, 2020. Pediatric patients (aged < 20 years) with non-accidental injuries were enrolled, which were divided by age into preschool (0-6 years), child (7-12 years), and adolescent (13-19 years) groups. Baseline characteristics, injury epidemiology, and excess mortality ratio-adjusted injury severity score (EMR-ISS) were collected. Major trauma was defined as an EMR-ISS score > 24. The study enrolled 451 patients with non-accidental injuries, accounting for 2.81% of pediatric trauma events presented to an emergency department in the PATOS registry. The overall mortality rate was 0.9%, similar to those in Western countries. Mortality rate was high in preschool children (8.7%, p = 0.017) than in other age groups. The sex-specific incidence was higher in boys (3.10% vs. 2.13%, p = 0.001). In adolescents, more events occurred on the street (25.9%), whereas home remained the most common locale in girls of all ages. In the multivariable regression analysis, abdominal and multiple injuries were risk factors for major trauma.

Figure 1

Study algorithm of patients included in the study. PATOS Pan-Asian Trauma Outcome Study.

Figure 2

Sex-specific and total percentages of non-accidental injuries among trauma events presenting to emergency departments (age at injury from 0 to 19 years).

Figure 3

Multivariable regression analysis and adjusted odds ratio of risk factors for non-major trauma versus major trauma. CI confidence interval, EMR-ISS excess mortality ratio-adjusted injury severity, OR odds ratio, 1 present, 0 absent.