351 - Associated Injuries in Occult Abdominal Trauma: Considering a Targeted Screening Approach

Tagrid Ruiz-Maldonado, University of Utah School of Medicine, Salt Lake City, UT, United States; Kristine A. Campbell, University of Utah School of Medicine, Salt Lake City, UT, United States; Joanne N. Wood, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Antoinette Laskey, University of Utah School of Medicine, Salt Lake City, UT, United States; Christopher Greeley, Baylor College of Medicine, Houston, TX, United States; Angela Bachim, Baylor College of Medicine, Houston, TX, United States; Carmen Coombs, Children's Hospital of PIttsburgh of UPMC, Pittsburgh, PA, United States; Jim Anderst, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Megan M.. Letson, Nationwide Children's Hospital, Columbus, OH, United States; Lori Frasier, Penn state hershey, Hershey, PA, United States; Nancy S. Harper, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Steven Pham, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Natalie Laub, University of California, San Diego School of Medicine, San Diego, CA, United States

Background: Recent research has revealed a 0.3% prevalence of occult abdominal trauma (OAT) among children evaluated for child physical abuse, raising concerns that universal transaminase screening in all children evaluated for suspected physical abuse is not warranted. Instead, a targeted approach to OAT screening has been suggested. Intra-abdominal injury in child physical abuse has been thought to result from direct trauma or from inertial trauma at points of organ fixation. Understanding the co-occurring injuries most likely to be associated with OAT can help guide a targeted approach to more effective screening practices.

Objective: We aimed to study the association between OAT and co-occurring injuries, specifically direct trauma to the torso. We hypothesized that OAT is more likely in cases with direct injuries to the torso than in cases without.

Design/Methods: We conducted a retrospective cross-sectional study using data from a multicenter child abuse research database (CAPNET) from February 2021 to August 2023. We included subjects < 60-months-old undergoing evaluation for physical abuse. Patients with history, signs, or symptoms suggesting abdominal trauma were excluded. Injury group was dichotomized based on documented physical findings of direct injuries. Direct injuries were defined as injuries localized to the torso and included chest or back bruising, thoracic fractures, or intrathoracic organ (i.e., lung and heart) injury. We calculated OAT prevalence and compared OAT in both groups using multivariable logistic regression adjusted for clinical severity and sociodemographic factors. Results for the adjusted regression model were reported using adjusted predicted probabilities (APP).

Results: Among 6895 eligible subjects, 1178 (17.1%) were categorized as direct injury. 21 cases of OAT were identified overall (0.3%) with 14 of these cases identified among direct injuries. Adjusting for clinical severity and sociodemographic factors, OAT was 9.5 times more common in cases with direct injuries to the torso than in cases without (APP 1.1% vs 0.1%, p< 0.001).

Conclusion(s): OAT is uncommon in child physical abuse evaluations. When detected, OAT is more commonly associated with direct injuries to the torso. While these findings may provide early steps towards developing a targeted approach to OAT screening, efforts to further OAT screening research should balance the scarcity of this finding as its low prevalence limits the generalizability of results.