The following is a summary of Knowing Your Patient Population: Techniques to Capture Infants at High Risk for Physical Abuse in a Trauma Registry,” published in the February 2024 issue of Pediatrics by Papillon et al.

Physical abuse poses a significant public health challenge, particularly among infants, leading to considerable morbidity and mortality. Clinical decision tools derived from trauma registries can aid in timely risk stratification. However, the Trauma Quality Improvement Program (TQIP) database lacks age reporting for children under 1 year, who are at the highest risk of abuse. Here, the researchers present a method to identify these vulnerable infants despite the absence of age data. Utilizing data from TQIP spanning 2017 to 2019, patients aged 17 years or younger were identified. Primary outcomes included injuries resulting from confirmed or suspected child abuse, captured through diagnosis codes or reports/investigations of physical abuse, or discrepancies in caregiver information at discharge. The study group employed two approaches to select infants within TQIP: first, the investigators utilized World Health Organization (WHO) growth standards for stature or length-for-age and weight-for-age to identify children younger than 1 year; second, the study group employed a K-means machine learning algorithm to cluster patients based on weight and height. 

Comparative outcome and injury data analysis was conducted with and without patients under 1 year. Results revealed that using WHO growth standards, the study group identified 19,916 children under 1 year, among whom 20,513 patients had reports of physical abuse filed, with 9,393 being infants under 1 year. The inclusion of infants led to increased age-adjusted odds ratios for various injuries, including fractures of the upper limb, vertebrae, ribs, spinal cord, and head injuries. 

In conclusion, in a nationwide trauma registry, employing WHO growth standards enables the identification of patients under one year who are disproportionately affected by maltreatment, thereby enhancing their ability to address this critical issue.

Source: sciencedirect.com/science/article/abs/pii/S0022346824000824