ABSTRACT Non-accidental injury (NAI) remain a major yet frequently underrecognized cause of morbidity and mortality among children presenting to emergency departments (EDs) worldwide. This systematic review synthesizes global evidence published between 2000 and February 2025 on the prevalence, risk factors, injury patterns, screening approaches, and outcomes of NAI in pediatric emergency settings. Twenty-two studies were included. Reported prevalence varied widely, ranging from 0.07% in expert-reviewed cohorts to over 8% in broad ED screening studies, reflecting substantial heterogeneity in study design and diagnostic thresholds. Infants younger than 6 months consistently represented the highest-risk group. Injury patterns most commonly associated with abuse included long-bone fractures, traumatic brain injury, immersion burns, and multiple injuries. Screening tools such as TEN-4-FACESp and ESCAPE demonstrated high specificity but variable sensitivity, indicating that a significant proportion of cases may remain undetected. Approximately 9% of affected children required hospitalization, whereas overall mortality was low (around 0.2%), though higher rates were reported among preschool-aged children. Child Abuse Pediatrics consultations frequently influenced diagnostic classification and increased referrals to child protective services. Overall, the findings highlight persistent gaps in recognition of NAI and underscore the need for improved screening, clinician training, and system-level support within pediatric EDs.
Hazazi et al. (Thu,) studied this question.