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Chen HH, Wang IA, Hsieh TW, Tsay JH, Chen CY. Early predictors for maltreatment-related injuries in infancy and long-term mortality: a population-based study. BMC Public Health 2023; 23:2232. [PMID: 37957616 PMCID: PMC10641954 DOI: 10.1186/s12889-023-17180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Incidence, health consequences, and social burden associated with child maltreatment appeared to be borne disproportionately by very young children. We conducted a population-based data linkage study to explore child- and family-level factors that affect receiving different diagnoses of maltreatment injuries and investigate excessive mortality throughout toddlerhood. METHODS We conducted a retrospective cohort study comprising 2.2 million infants born in 2004-2014 in Taiwan. Incident cases of child maltreatment were defined by hospitalization or emergency department visits for three heterogeneous diagnostic groups of maltreatment-related injuries (i.e., maltreatment syndrome, assaults, and undetermined causes) within 12 months after birth. The generalized linear model and landmark survival analyses were used to evaluate risk factors. RESULTS An estimated 2.9‰ of infants experienced at least one maltreatment-related injury, with a three-year mortality rate of 1.3%. Low birthweight was associated with increased risk of receiving the diagnosis of three maltreatment injuries, particularly maltreatment syndrome (adjusted Incidence Rate Ratio [aIRR] = 4.08, 95% confidence interval [CI]: 2.93-5.68). Socially advantaged family condition was inversely linked with receiving the diagnosis of maltreatment syndrome and assaults (e.g., high income: aIRR = 0.55 and 0.47), yet positively linked with undetermined cause (aIRR = 2.05, 95% CI: 1.89-2.23). For infants exposed to maltreatment, low birth weight and non-attendance of postnatal care were highly predictive of fatality; low birthweight served as a vital predictor for premature death during toddlerhood (aIRR = 6.17, 95% CI: 2.36-15.4). CONCLUSIONS Raising awareness of maltreatment-related injuries in infancy and predictors should be a priority for appropriate follow-up assessment and timely intervention.
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Affiliation(s)
- Hsin-Hung Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
- Division of Pediatric Neurosurgery, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-An Wang
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Tan-Wen Hsieh
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Jen-Huoy Tsay
- Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Chuan-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.
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Cercone DJ, Berger RP, Manole MD, Soung JK, Coombs CM, Noorbakhsh KA. Increased severity of abusive head trauma during the first year of the COVID-19 pandemic. CHILD ABUSE & NEGLECT 2023; 135:105971. [PMID: 36427395 PMCID: PMC9676164 DOI: 10.1016/j.chiabu.2022.105971] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Abusive head trauma (AHT) is the leading cause of death from physical abuse in children. Reports regarding the impact of the COVID-19 pandemic on rates and severity of AHT are limited and with conflicting results. OBJECTIVE To determine the number and clinical characteristics of AHT cases presenting to a pediatric tertiary care center during the first year of the COVID-19 pandemic compared to the two prior years. PARTICIPANTS AND SETTING We performed a retrospective cohort study of patients <5 years old diagnosed with AHT at a single pediatric tertiary care center over a three-year period. METHODS Data were obtained for the pandemic year and two years before, including demographics, length of stay, physical and retinal examination findings, radiologic studies, electroencephalogram results, and mortality. RESULTS There were 27 cases of AHT during the first year of the pandemic and 55 during the two pre-pandemic years. Length of stay was similar for the two cohorts. The mortality rate was higher during the pandemic (29.6 % vs. 3.6 %; p < .01), as were the proportion of patients with retinal hemorrhages (84.6 % vs. 41.5 %; p < .01) and abnormal cervical spine imaging (52.6 % vs. 21.2 %; p = .02). There were no differences in age, sex, race, abnormalities on dermatological exam, skeletal surveys, and electroencephalograms. CONCLUSIONS We did not observe an increase in the number of patients with AHT during the pandemic but did see an increase in mortality, patients with retinal hemorrhages, and patients with abnormalities on cervical spine imaging. These data suggest a higher severity of AHT presenting to a pediatric tertiary care center during the pandemic.
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Affiliation(s)
- Dominic J Cercone
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Rachel P Berger
- Division of Child Advocacy, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Mioara D Manole
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Jane K Soung
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Carmen M Coombs
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States; Division of Child Advocacy, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
| | - Kathleen A Noorbakhsh
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
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Peterson BL, Arnall M, Avedschmidt S, Beers D, Bell M, Burton S, Case M, Catellier M, Cina S, Cohle S, Collins K, Covach A, Downs J, Ely E, Ely S, Fajardo M, Fierro M, Fowler D, Frost R, Fudenberg J, Fusaro A, Gill J, Gilson T, Glenn C, Goldfogel G, Graham S, John Greenwell P, Ann Grossberg L, Gulledge C, Handler M, Hansma P, Harshbarger K, Hawes A, Hellman F, Heninger M, Hlavaty L, Hoyer P, Johnson D, Jorden M, Kelley D, Kesha K, Kohr R, Krywanczyk A, Lehman L, Lochmuller C, Luzi S, Mathew A, McDonough E, Mileusnic D, Miller E, Milroy C, Morrow P, Oliver W, Orvik A, Pandey M, Parsons T, Pfalzgraf R, Philip A, Poulos C, Prahlow J, Pustilnik S, Radisch D, Rao V, Raven K, Resk T, Ross K, Rudd T, Schmidt C, Schmunk G, Ann Sens M, Shelly M, Snell K, Sperry K, Stables S, Stahl-Herz J, Steckbauer M, Super M, Tarau M, Thogmartin J, Tormos L, Tse R, Utley S, Vega R, Williams K, Wolf B, Wright R. Commentary on: Dror IE, Melinek J, Arden JL, Kukucka J, Hawkins S, Carter J, et al. Cognitive bias in forensic pathology decisions. J Forensic Sci. https://doi.org/10.1111/1556-4029.14697. Epub 2021 Feb 20. J Forensic Sci 2021; 66:2541-2544. [PMID: 34498736 DOI: 10.1111/1556-4029.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Dean Beers
- Associates in Forensic Investigations, LLC, Larimer, CO, USA
| | | | | | - Mary Case
- St. Louis County Medical Examiner's Office, St. Louis, MO, USA
| | | | - Stephen Cina
- Cina and Cina Forensic Consulting, PC, Loveland, CO, USA
| | - Stephen Cohle
- Kent County Medical Examiner Office, Grand Rapids, MI, USA
| | | | - Adam Covach
- Fond du Lac County Medical Examiner's Office, Fond du Lac, WI, USA
| | | | - Erin Ely
- St. Louis County Medical Examiner's Office, St. Louis, MO, USA
| | - Susan Ely
- Office of the Chief Medical Examiner, New York, NY, USA
| | - Mark Fajardo
- Riverside County Sheriff-Coroner's Office, Perris, CA, USA
| | | | | | | | - John Fudenberg
- Clark County Office of the Coroner/Medical Examiner, Las Vegas, NV, USA
| | - Aldo Fusaro
- Montana State Medical Examiner, Missoula, MT, USA
| | - James Gill
- Connecticut Office of the Chief Medical Examiner, Farmington, CT, USA
| | - Thomas Gilson
- Cuyahoga County Medical Examiner's Office, Cleveland, OH, USA
| | - Charles Glenn
- North Forensic Pathology Service, Auckland, New Zealand
| | - Gary Goldfogel
- Whatcom County Medical Examiner Office, Bellingham, WA, USA
| | | | | | | | | | - Michael Handler
- Neuropathology & Forensic Pathology Consulting Inc, Overland Park, KS, USA
| | | | | | - Amy Hawes
- Office of the Tennessee State Medical Examiner, Clinton, TN, USA
| | | | | | - Leigh Hlavaty
- Wayne County Medical Examiner's Office, Detroit, MI, USA
| | | | | | - Michelle Jorden
- Santa Clara County Medical Examiner's Office, San Jose, CA, USA
| | - Douglas Kelley
- Milwaukee County Medical Examiner's Office, Milwaukee, WI, USA
| | - Kilak Kesha
- North Forensic Pathology Service, Auckland, New Zealand
| | - Roland Kohr
- Terre Haute Regional Hospital, Terre Haute, IN, USA
| | | | - Lee Lehman
- Montgomery County Coroner's Office, Dayton, OH, USA
| | | | - Scott Luzi
- Anatomic, Clinical, and Forensic Pathology Services, Escondido, CA, USA
| | - Ashley Mathew
- Office of the State Medical Examiner, Louisville, KY, USA
| | | | | | | | - Chris Milroy
- Division of Anatomic Pathology, The Ottawa Hospital, Ottawa, Canada
| | - Paul Morrow
- North Forensic Pathology Service, Auckland, New Zealand
| | - William Oliver
- Knox County Regional Forensic Center, Knoxville, TN, USA
| | - Andrea Orvik
- Montana Medical Examiner's Office, Billings, MT, USA
| | | | - Thomas Parsons
- Lubbock County Medical Examiner's Office, Lubbock, TX, USA
| | | | - Abraham Philip
- Cobb County Medical Examiner's Office, Marietta, GA, USA
| | | | - Joe Prahlow
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | | | | | - Valerie Rao
- District 12 Medical Examiner's Office, Sarasota, FL, USA
| | | | | | - Karen Ross
- Fort Bend County Medical Examiner's Office, Rosenberg, TX, USA
| | | | - Carl Schmidt
- Wayne County Medical Examiner's Office, Detroit, MI, USA
| | | | - Mary Ann Sens
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Mark Shelly
- Maricopa County Office of the Medical Examiner, Phoenix, AZ, USA
| | - Kenneth Snell
- Minnehaha County Coroner/Medical Examiner's Office, Sioux Falls, SD, USA
| | - Kris Sperry
- Forensic Pathology Consultant, Peachtree City, GA, USA
| | - Simon Stables
- North Forensic Pathology Service, Auckland, New Zealand
| | - Jay Stahl-Herz
- New York City Office of the Chief Medical Examiner, Brooklyn, NY, USA
| | | | - Mark Super
- Super Forensic Pathology, El Dorado Hills, CA, USA
| | - Marius Tarau
- Jackson County Medical Examiner's Office, Kansas City, MO, USA
| | | | - Lee Tormos
- District 15 Medical Examiner's Office, Palm Beach, FL, USA
| | - Rexson Tse
- North Forensic Pathology Service, Auckland, New Zealand
| | - Suzanne Utley
- District 12 Medical Examiner's Office, Sarasota, FL, USA
| | - Russell Vega
- District 12 Medical Examiner's Office, Sarasota, FL, USA
| | | | - Barbara Wolf
- Districts 5 & 24 Medical Examiner's Office, Leesburg, FL, USA
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