National Trends in Non-Accidental Pediatric Craniofacial Fractures Requiring Inpatient Admission.

Abstract

Introduction: Pediatric craniofacial trauma, particularly from non-accidental trauma (NAT), is a significant cause of injury with enduring physical and psychological impacts. This study analyzes demographic patterns, injury characteristics, and trends in NAT-related craniofacial injuries to inform early identification, intervention, and prevention efforts.

Methods: Analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed for the years 2009 to 2019. Patients aged 0 to 17 with craniofacial injuries and a diagnosis of non-accidental trauma were identified based on current procedural codes; demographic and temporal trends were analyzed.

Results: Overall, 306,115 patients with craniofacial injuries and 20,540 patients with non-accidental trauma (NAT) were identified. Patients with NAT represented 2.6% of all craniofacial injuries, with a greater proportion of males affected. On average, 39% of all NAT cases involved a craniofacial injury. The most common injury patterns were intracranial (50.1%), superficial head injuries (37.7%), and craniofacial fractures (31.9%. Isolated facial fractures were rare, comprising <1% of all cases. Although the average in-hospital mortality was 6.78%, temporal analysis demonstrated significant reductions in in-hospital mortality and length of hospitalization ( P <0.001).

Conclusions: Pediatric craniofacial injuries from NAT remain a significant public health concern. However, the observed decrease in both hospitalization length and in-hospital deaths suggests improvements in early intervention and treatment outcomes. Continued efforts to refine diagnostic strategies, enhance provider awareness, and strengthen prevention initiatives are essential to mitigate the devastating impacts of NAT in the pediatric population.