the peculiarities and comparison of non accidental and accidental pediatric trauma

L. Radevičiūtė. The pecularities and comparison of non accidental and accidental pediatric trauma. The final thesis of Medicine programme, Lithuanian University Of Health Sciences, Medical academy, Department of Pediatrics, Kaunas, 2016. Aim. To evaluate and compare the pecularities of accidental and non accidental pediatric trauma. Objectives. 1. To evaluate gender and age related differences of the accidental and non accidental trauma. 2. To assess the risk factors of abuse between accidental and non accidental trauma groups: the family structure, the number of children in the family, the preterm newborns. 3. To evaluate the gravity of the accidental and non accidental trauma using Glasgow coma scale (GCS), Pediatric trauma score (PTS), the duration of treatment in the pediatric departement and pediatric intensive care unit. 4. To compare the type and frequency of the accidental and non accidental trauma injury, performed surgical intervations, residual neurological deficit. 5. To make an assessment in the non accidental trauma group of this data: the cause of seeking medical attention, the pecularities of medical history, the signs of neglect, the type and frequency of typical non accidental injuries, the fulfilment of abuse diagnostic quidelines. Methods. The retrospective study was conducted in The Pediatric Intensive Care Unit in the hospital of Kaunas clinics of Lithuanian University of Health Sciences. The object of the study - the medical documentation of children treated in the Pediatric Intesive Care Unit during the 5 years period (2011-2015). The analysis consisted of 73 medical histories which divided in 22 - belonging to the children with non accidental trauma and 51 – to accidental trauma. Results. The study showed that abuse was more common among boys than girls. The average age of children with non accidental trauma was 10 months compared with 16 months of accidental trauma‘s average age. The condition by GCS in the accidental trauma group most commonly was minor (70,6%) while the half of children of non accidental trauma evaluated condition was moderate (22,7%) and severe (22,7%) although the relation was not significant. The non accidental trauma was significantly more frequent in the incomplete families (70 %) while the accidental trauma was more common in the complete families - 76,2 %. The average treatment time in the Pediatric department of non accidental trauma was 20 days and in the Pediatric Intensive Care Unit – 7 days, the accidental trauma was treated accordingly 7 and 2 days. The surgical interventions were performed more frequently to the children suffering from abuse (45,5%). The residual neurologic deficit was observed 42,9% after the non accidental trauma and 3,9% after the accidental trauma. The typical non accidental trauma injuries were not observed in the majority of accidental trauma cases (54,9%). The most common injuries in the non accidental trauma were body hematomas (50%) and bone fractures (59%). In combination with other injuries 8 children were diagnosed with bilateral retinal hemorrhages, 6 – with subdural hematoma, 4 – with bruises in the atypical body locations, 3 – with chronical subdural hematoma, 1 – with old bone fractures. The study showed that the majority of children were examined according to the abuse diagnostic guidelines: neurological examination was performed in 95,5% cases, ophtalmologic – 86,4%, full radiologic examination - 59,1%, partially full radiologic examination – 40,9%, blood clotting test – 59,1%. Conclusions. 1. The non accidental trauma was more common in younger children than accidental trauma (p 0,05). 2. The non accidental trauma significantly was more common in an incomplete families that the accidental (p 0,05). All the preterm children (n=3) suffered from abuse. 3. The condition by PTS of non accidental trauma was significantly more severe than accidental trauma PTS (p0,05). The duration o fthe treatment was significantly longer of children in the non accidental trauma group (in the Pediatric departement p< 0,01, in the Pediatric Intensive Care Unit p<0,03). 4. The surgical interventions were performed significantly more often in the non accidental trauma group (p<0,025). The most commonly performed type of surgery in non accidental trauma group was neurosurgery while in the accidental trauma group – ortopedic surgery (p<0,047). The residual neurological deficit was more often diagnosed after non accidental trauma than the accidental trauma (p<0,001). The typical non accidental injuries were diagnosed more commonly in the non accidental trauma group (p