Pediatrics: Development of a Systematic Protocol to Identify Victims of Non-Accidental Trauma-Pediatrics: Development of a Systematic Protocol to Identify Victims of Non-accidental Trauma

Pediatrics: Development of a Systematic Protocol to Identify Victims of Non-accidental Trauma

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The document discusses the development of a systematic protocol to identify victims of non-accidental trauma (NAT). The objective is to recognize that 48% of child fatalities each year are a result of physical abuse, with the majority of these children being under 4 years old. Only 56% of cases are evaluated by a pediatric surgeon. The document also highlights the importance of identifying risk factors and implementing systematic screening programs to prevent escalation of injuries and improve outcomes. <br /><br />The development of the protocol began in 2012 with ad-hoc meetings and was formalized in 2013 under the MBCH Pediatric Trauma Committee. System-wide training was conducted in 2013, and a standardized assessment tool was implemented on January 1, 2014. The tool includes prompts for data collection, standardized history and physical exams, and referrals to relevant departments. <br /><br />The document lists red flags for identifying victims of non-accidental trauma, including missing/inconsistent history, unwitnessed injury, delay in seeking care, prior ED visits, domestic violence in the home, and abnormal physical exam findings. Radiographic findings such as fractures, subdural/subarachnoid hemorrhage, and abdominal injuries are also red flags. <br /><br />Retrospective data from 2010-2013 shows that 89% of cases had inconsistent or missing history, 57% of patients had bruising, and 60% of patients under 1 year old had new fractures. Nine fatalities were recorded during this period. The document emphasizes the need for standardized assessment and proactive communication with parents to address suspected NAT cases. Future research includes a prospective study to evaluate the standardized tool and system-wide evaluation of current practices. <br /><br />The document concludes that a standardized protocol has raised system-wide awareness of NAT and hopes to provide data in the future to support this observation. Funding for the research was provided by the Heidner Charitable Trust and sponsored by the MultiCare Institute for Research & Innovation.

Keywords

systematic protocol

non-accidental trauma

child fatalities

physical abuse

pediatric surgeon

risk factors

screening programs

red flags

standardized assessment tool

proactive communication