Should Children with Suspected Nonaccidental Injury Be Admitted to a Surgical Service?

Abstract

In many hospitals, children with suspected nonaccidental trauma (sNAT) are admitted to nonsurgical services (NSS). Although the surgical service (SS) initially admitted sNAT patients at our American College of Surgeons (ACS)-verified level 1 pediatric trauma center (vPTC), a change in hospital policy allowed admission to NSS. The objective of this study was to determine if the rate of care-related indicators (CRIs) varies by admission to an SS vs an NSS in the sNAT patient population. We conducted a retrospective review of patients admitted to an ACS vPTC with a final diagnosis of sNAT between January 2009 and December 2013. The primary study outcome was the presence of a CRI. Surgical service and NSS admissions were compared on age, Injury Severity Score, and Abbreviated Injury Scale to account for population differences among admissions by service and type of CRIs, using chi-square or Fisher's exact and Mann-Whitney tests. Rates of CRIs over time were also evaluated. During the study period, 5,340 total patients were admitted-671 (13%) with sNAT. Nonsurgical services admitted 306 patients (46%) of these patients, but 71% (n = 102) of the CRIs occurred in patients admitted to an NSS. The rate of CRIs per 100 patients was 33 for NSS compared with 12 for SS (p < 0.001). The overall rate of CRIs for sNAT increased from 18 to 26 (p = 0.07) per 100 patients after the policy change. Nonaccidental trauma patients admitted to an NSS were shown to have more CRIs than those admitted to an SS. This study supports an ACS requirement of admission of sNAT to an SS.