Extended length of stay in children admitted to a quaternary orthopaedic ward with suspected non‐accidental injury
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Abstract
Background. Tertiary hospitals, and specifically orthopaedic surgeons, have a crucial role in identifying suspected cases of child abuse, but such facilities are not an appropriate setting for long-term management.
Objective. To compare patient profiles in a local setting with those described in international literature to address risk factors for non- accidental injuries (NAI) and those prolonging hospitalisation for suspected cases.
Methods. Records were analysed of patients admitted to the Paediatric Orthopaedic Unit at Charlotte Maxeke Johannesburg Academic Hospital and referred for investigation for suspected NAI or neglect between 1 January 2015 and 31 December 2020. Data collected included demographic information, injury details and admission data.
Results. A total of 79 cases were reviewed, of whom 44 (55.7%) were South African citizens and 35 were foreign nationals (91% undocumented). Three-quarters (75.9%; n=60) of the patients were <36 months. Delayed discharge was found in two-thirds (65.8%) of cases, primarily associated with younger age and significantly correlated with upper-limb fractures and involvement of governmental social welfare services. Only 9% of cases referred to a regulatory body were subsequently moved to a place of safety.
Conclusion. Despite no significant correlations found between patient demographics or caregiver characteristics and extended hospital stays, factors such as patient age (<36 months) and upper-limb fractures were associated with delayed discharge. Delays were also influenced by the time taken to complete investigations, with involvement by governmental social welfare services significantly prolonging discharge. This study highlights the need for improved resources to investigate and manage these vulnerable children.
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