(1759) Assessing Non-Accidental Trauma Screening in Pediatric Patients With Out-of-Hospital Cardiac Arrest

Introduction: Non-accidental trauma (NAT) is a serious yet potentially preventable cause of morbidity and mortality in pediatric trauma patients. NAT incidence is estimated as 1-12% of pediatric traumas but likely underreported due to the varying presentations and young age of patients. Some of these patients present as out of hospital cardiac arrest (OHCA). NAT evaluation and diagnosis are crucial from a medicolegal standpoint. As this evaluation is not standardized, we hypothesized that NAT screening would be incomplete in most OHCA patients.

Methods: This study retrospectively evaluated 313 patients with OHCA ages 0-5 years admitted to the PICU at a level one trauma center from 2015-2024 for the presence of NAT screening. The following 7 criteria as sourced from the child advocacy team were used: urine/serum drug investigation within the first 24 hours of admission, skeletal survey, comprehensive metabolic panel, neuroimaging, detailed skin exam, social work, and child advocacy consults. OHCA was categorized by etiology. We summated the proportion of patients with partial and complete screening items.

Results: The age was distributed as 0.75 (0.25, 1.67) years. 41/313 (13.1%) patients had complete NAT screenings. On average, a patient had 3.62 ± 1.92 parameters completed. CMP was most likely to be completed (85.3%), followed by social work consult (69.7%), and neuroimaging (67.1%). Skeletal survey was least likely to be completed (17.3%). In terms of OHCA etiology, trauma unrelated to NAT was the leading cause (17.9%), followed by NAT (15.7%), and respiratory complications both infectious (15.0%) and non-infectious (16.3%). 8 patients had an unknown etiology of arrest (2.6%) where screening was complete in 1 patient with a distribution of 2.5 (2.0, 5.25) parameters. In those fully screened, NAT incidence was 75.6% whereas among those not fully screened it was 6.6%.

Conclusions: NAT work up is frequently incomplete in children aged 0-5 years with a presentation of OHCA at admissions. There are possible missed NAT diagnoses given the 6.6% prevalence of NAT among the incompletely screened patients. Existing high clinical suspicion for NAT can generate a bias for which patients are screened, necessitating a standardized method to ensure that all patients receive appropriate care.