Current Appraisal of Racial and Ethnic Disparities in Suspected Child Abuse Among Young Children Presenting with Acute Head Trauma

Background: Previous studies demonstrate race/ethnicity-based differences in child abuse evaluations among children presenting with acute head trauma (aHT); however current analyses are lacking. We evaluated a large cohort of young children presenting with aHT for factors associated with concurrent clinician suspicion for child abuse, including race/ethnicity.

Methods: We performed a cross-sectional study of Military Health System (MHS) beneficiaries born between fiscal year 2016 and 2018. Each patient was observed for 2.5 years after birth to assess for the occurrence of aHT using ICD-10 diagnostic codes. Among patients with aHT codes, we performed multivariable logistic regression analysis to measure the association between race/ethnicity, as well as other demographic factors, and the concurrent use of the ICD-10 diagnostic code for suspected child abuse (SCA) or performance of a skeletal survey.

Results: We identified 195,893 infants born between fiscal year 2016 and 2018, of whom 45,269 (23%) underwent medical evaluation for HT within the first 2.5 years of life. Less than one percent (n=424 of 45,269) concurrently had the ICD-10 code for SCA or a skeletal survey performed within two weeks of the aHT evaluation. When controlling for other factors, race/ethnicity was not associated with SCA. Children with three or more evaluations for aHT or those presenting to either the Emergency Room (ER) or those admitted to the hospital all independently demonstrated increased odds of SCA (Table 1). Patients with aHT and any of the following: age ≥ 1 year old, military sponsor in the Air Force, military sponsor rank above Junior Enlisted, or not seen by a Pediatrician, independently had decreased odds of SCA.

Conclusion: In contrast to previously published data, we observed no differences in SCA by race among young children presenting with aHT. Of note, the demographic factors we observed to be associated with increased odds of SCA are largely in line with established warning signs. Further analyses are needed to understand the observed association between SCA and military rank as well as branch of service. Follow on analyses should also focus on updated evaluations of racial disparities in SCA among other common childhood injuries.