Child-Abuse Injuries on the Rise By CRYSTAL PHEND, MedPage Today Senior Staff Writer A national study found that serious injuries from child abuse appear to have risen modestly over the past decade or so, and suggested that downward trends in other studies of abuse may reflect reporting changes rather than real improvement. Hospitalization for abuse-related injury rose 4.9 percent overall among children 18 and under over the 12-year span from 1997 through 2009, wrote Dr. John Leventhal and Julie Gaither, both of Yale University in New Haven, Conn. Children were increasingly likely to die from these injuries before discharge as well, they reported in the November issue of Pediatrics. Read this story on www.medpagetoday.com. However, "these results are in sharp contrast to data from child protective services," they noted. A national reporting system from these agencies indicated a 55 percent decline in substantiated child abuse cases from 1992 through 2009. A second more extensive report by the Congress-mandated National Incidence Studies suggested a 23 percent decline in physical abuse. While called evidence of "positive changes in the provision of services to children and families, there have been concerns that some of this decrease may be due to changes in reporting of cases to child protective services agencies and changes in which cases get investigated by child protective services and which cases are actually substantiated as physical abuse," Leventhal and Gaither wrote. One reason for the divergence may be that the studies are documenting a slightly different phenomenon, they suggested. The child protective services data reflected physical abuse regardless of age or severity, whereas children under age 1 accounted for 54 percent of cases in the hospitalization data. "Thus, perhaps all physical abuse is decreasing in the United States, but injuries in very young children have not followed this overall trend," the investigators wrote. Shifts in how child abuse is counted are more likely to account for the differences, though, the pair proposed. The results "highlight the challenge of using a single source of data to track a complex problem such as child physical abuse," they wrote. Their analysis of the Kids' Inpatient Database, which samples acute care discharges from U.S. hospitals, tracked serious injury, abuse, certain kinds of assault, and perpetrator of abuse codes every 3 years from 1997 through 2009. During that period, the incidence of serious injury linked to abuse rose from 6.1 per 100,000 children ages 18 and under in 1997 to 6.4 per 100,000 in 2009. Most of that upward trend was accounted for by abuse of the youngest children. Serious injury incidence rose 10.9 percent among those under 1 year of age. Older children actually saw a decrease of 9.1 percent from 3.3 to 3.0 per 100,000 children from 1997 to 2009. Most of the serious abuse-related injuries were fractures, which rose from 40.2 percent in 1997 to a peak of 48.5 percent in 2009. Injuries to the skin or open wounds also rose to account for 41.6 percent of the injuries in 2009. Traumatic brain injury accounted for at least a third of the injuries across study periods. Burns, abdominal injuries, and other injuries accounted for about 10 percent each. While the duration of hospitalizations for severe injury due to child abuse didn't change over the 12-year period, in-hospital death due to abusive injuries rose from 0.25 to 0.36 per 100,000 children. "Because there has been no decrease in the incidence of hospitalizations due to serious abuse in children, our results highlight the need to develop prevention programs that can reduce this significant morbidity (and mortality)," the investigators concluded. Limitations of the study included inability to determine if medical records became more specific over time regarding abuse, reliance on administrative codes, and inability to control for quality of medical care.