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INTRODUCTION: Non-accidental trauma (NAT) is a leading cause of pediatric traumatic brain injury (TBI). Recent studies suggest NAT results in worse outcomes than accidental TBI, independent of severity of the injury and interventions. METHODS: Patients under 18 years old diagnosed with head trauma with or without NAT during 2019-2021 were identified in the NTDB. The predictor variables were demographics; previously validated prognostic factors , including motor score, verbal score, pupillary score, pupillary reactivity, image findings; neurosurgical interventions including EVD, ICPM, PbO2 monitoring; length of stay, and number of ventilated days. Data evaluation and univariate analysis were performed using summary statistics, t-tests, chi-square tests, and non-parametric tests. Mortality, length of ICU stay and complication rates were modeled using a multivariate logistic regression model. Outcomes were controlled for age, race, sex, and teaching vs nonteaching hospital. RESULTS: A total of 90,607 pediatric TBI events were identified in the database, 1721 (1.90%) cases with NAT. NAT was observed most often in 0-2 year-olds (64.78%), followed by 2-5 year-olds (22.66%), 6-10 and 15-18 year-olds (0.09% each), then 11-14 year-olds (0.07%). Patients with NAT had longer ICU stays (6.18 vs 4.93 days, p < 0.0001) and ventilator days, despite similar injury severity scores (p < 0.0001). In-hospital mortality was 30% more likely if NAT was the MOI (LR 1.3046, p < 0.001). CONCLUSIONS: Pediatric TBI patients with NAT have worse inpatient outcomes than similar patients with accidental injuries. Accurate diagnosis and better prognostication scales specific to patients with non-accidental trauma may lead to improved management and resource allocations for these sicker patients.
Nosova et al. (Fri,) studied this question.