P0972 - Increased Mortality in Very Young Children with Traumatic Brain Injury due to Child Abuse: A Nationwide Analysis of 10,964 Patients

Background:
Traumatic brain injury (TBI) is the leading cause of death and disability in children with worse outcomes in younger children; however, the impact of mechanism on outcomes has not been fully evaluated. We hypothesized that children with TBI due to child abuse would have higher mortality than children with TBI due to motor vehicle collisions (MVC).

Methods:
We performed a retrospective review of the national Kids’ Inpatient Database of children < 2 years old with TBI due to child abuse or MVC from 2000-2016. The primary outcome was mortality. Secondary outcomes were length of stay (LOS) and hospital charges. We investigated factors associated with in-hospital mortality in a multivariable regression model.

Results:
Of 10,964 patients identified, 65.2% had TBI due to abuse. Overall mortality was 9.8% (n = 1074). Abused children had a longer LOS (10.2 days vs 5.2 days, p<0.0001) and higher hospital charges ($71,914 vs $45,614, p<0.0001) than children with TBI due to MVC. The odds of mortality among abused children with TBI was 55% higher than TBI due to MVC (OR 1.55, 95% CI 1.21-1.99, p=0.0006) after adjusting for age, race, sex, injury severity, insurance, and hospital region.

Conclusion: Children with traumatic brain injury due to child abuse experience increased mortality compared to children with TBI due to motor vehicle collisions, in addition to having longer hospital length of stay and total hospital charges. Given the increased burden on the health care system and the dire outcomes for these vulnerable children, resources must be directed at both prevention and early identification of abuse.