Uniformed families, unequal outcomes?: A multicenter retrospective study of non-accidental trauma in military and civilian children

BACKGROUND: Non-accidental trauma (NAT) or child physical abuse (CPA) is associated with many social factors, including low socioeconomic status, mental health difficulties, and substance use. Military families are uniquely vulnerable to abuse, particularly during periods of increased stress. NAT outcome data in military-dependent children are limited to a single-center study showing longer length of stay (LOS), higher mortality, and more complications. METHODS: A retrospective review was conducted of patients (≤18 years) with NAT at eight US children's hospitals from 2018 to 2023, diagnosed by each center's multi-disciplinary child protection team. Military affiliation was determined by insurance coverage or self-identification. The primary outcomes were mortality and LOS. Secondary outcomes included the number of specialty consultations, need for operations, and 30-day readmissions. Comparisons were made between military and civilian patients. RESULTS: Among 907 NAT patients, 112 (12.3%) were military-affiliated, and 565 (62%) were male. Military patients were significantly younger, more likely to be the only child, and lived in less disadvantaged areas. The mechanism of injury, median Glasgow Coma Scale (GCS), and Injury Severity Score (ISS) did not differ between cohorts. Military children had a higher median LOS than civilian patients but equivalent mortality. CONCLUSION: In a large, multicenter study, military children affected by NAT were younger and had a longer LOS, despite equivalent ISS. Military families were less likely to have many typical psychosocial factors associated with NAT, such as law enforcement involvement and low socioeconomic status. However, these patients were more likely to be the only child in the household. These findings suggest that military families with young children and limited family support may represent an important population for targeted screening and early-support interventions, especially during periods of operational stress. LEVEL OF EVIDENCE: III.