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Abstract
Aims Analysis of the demographics, patterns of presentation and outcomes of all children <1yr old presenting with injuries to 9 Emergency departments in one health board over a 3 month period, with critical analysis of those requiring full child protection investigation.
Methods The Health Board has 9 Emergency departments, and in a 3 month period in 2014, 2531 children attended. A protocol for ‘Recognition and management of maltreatment in infants’ exists, and 388 infants met the inclusion criteria of presentation with injury. Case records for 375 children were able to be analysed for demographics; previous attendances; nature of injury; environmental risk factors for NAI; investigations; and follow up where welfare concerns were identified.
In cases where injury were found the majority of infants, (59%) presented with head injury. Burns (9%) and lacerations (6%) were next most prevalent
Accidental injury was the concluding diagnosis in 97%. 11 (2.9%) children fulfilled the protocol criteria for full child protection investigations consisting of skeletal survey, intracranial imaging, ophthalmology review and bloods. All 11 were admitted to the ward for investigation where the mean length of stay was 4.5 days
Results 375 children <1 yrs presented with injuries, 42.6% female, 56.8% male. Age at attendance rose from 1.9% <1 month to a peak of 17.3% at 11 months.
Of these 11 infants, the conclusion was that 4 were accidental injury, 4 remained unexplained and 3 were NAI.
Conclusion We describe the presentation of injuries in a large group of children under the age of 1, of whom 2.9% fulfilled the criteria for full child protection investigation. Only 7 (1.8%) were deemed to have NAI or unexplained injury. The majority had a multi-agency child protection case conference with safeguarding plans agreed prior to discharge, following which all were returned to parental care or kinship care.