Forthcoming Issue Vol. 19 no. 2 Extended length of stay in children admitted to a quaternary orthopaedic ward with suspected non-accidental injury
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Abstract
Introduction
The South African scenario, shaped by historical segregation and economic disparities, underscores the complexity of addressing child abuse. Orthopaedic surgeons play a crucial role in identifying suspected cases of child abuse. Studies have identified various risk factors which cumulatively increase the risk of maltreatment.
Tertiary hospitals are pivotal in detecting child abuse cases yet lack resources for long-term management. These units foster collaboration between healthcare and child welfare services. While the American Academy of Pediatrics has recommended admission to work up suspected child abuse, hospitals are not an appropriate setting for long term management.
Objective
Our study aimed to compare patient profiles with international literature to inform future management protocols and to quantify and address factors prolonging hospitalisation for suspected non-accidental injuries (NAI).
Methods
The study, conducted in the Paediatric Orthopaedic Unit, analysed records of patients referred to the Teddy Bear Clinic (TBC). It included children admitted to orthopaedics for suspected non-accidental injuries (NAI) or neglect. Data collected included demographic information, injury details, and admission specifics.
Results
There were 39 female and 40 male patients in the cohort with a median age of 20 months. Forty-four children (55.7%) were South African, 35 children were foreign nationals. Of the foreign nationals 91% were undocumented.
Sixty patients were under 36 months, with a median age of 20 months. About 65.8% experienced delayed discharge, primarily associated with younger age. Statistically significant correlations were found between delayed discharge and upper limb fractures, involvement of child welfare, and longer investigation completion times. Delayed discharge was notably prolonged when child welfare was involved, with a median delay of 32 days. Only 9% of cases referred to a regulatory body were removed to a place of safety, highlighting complexities in discharge decisions.
Discussion
In our cohort of 79 patients, 75.9% were younger than 36 months, consistent with findings showing most cases of NAI occur in children under three years old. Statistical analysis revealed insignificance in other social factors.
The review highlights some challenges of managing suspected child abuse cases in the hospital setting. Despite no significant correlations found between patient demographics or caregiver characteristics and extended hospital stays, patient age under 36 months and upper limb fractures were associated with delayed discharge. Delays were also influenced by the time taken to complete investigations, with Child Welfare involvement significantly prolonging discharge. This study highlights the need for improved referral channels to safeguard these vulnerable children.
Article Details
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