Factors for Recurrent Injuries in Victims of Suspected Non-Accidental Trauma: A Retrospective Cohort Study

Background Many children who are victims of non-accidental trauma (NAT) may be repeatedly evaluated for injuries related to maltreatment. The purpose of this study was to identify risk factors for repeated injuries in children with suspected NAT. Methods We conducted a retrospective cohort study using claims data from a pediatric Medicaid accountable care organization. Children with birth claims and at least one non-birth related claim indicating a diagnosis of NAT or skeletal survey in 2007–2011 were included. Recurrent events were defined as independent episodes of care involving an urgent/emergent care setting that included a diagnosis code specific for child abuse, a CPT code for a skeletal survey, or a diagnosis code for an injury suspicious for abuse. Cox proportional hazards models were used to examine risk factors for recurrent events. Results Of the 1,361 children with suspected NAT, a recurrent NAT event occurred in 26% within 1 year and 40% within 2 years of their initial event. Independent risk factors for a recurrent NAT event included a rural residence, age \u3c 30 months old, having only 1 or 2 initially detected injuries, and having a dislocation, open wound, or superficial injury at the previous event (p ≤ 0.01 for all). Conclusions Over 25% of children who experienced a suspected NAT event had a recurrent episode within one year. These children were younger and more likely to present with “minor” injuries at their previous event

First radial velocity results from the MINiature Exoplanet Radial Velocity Array (MINERVA)

The MINiature Exoplanet Radial Velocity Array (MINERVA) is a dedicated observatory of four 0.7m robotic telescopes fiber-fed to a KiwiSpec spectrograph. The MINERVA mission is to discover super-Earths in the habitable zones of nearby stars. This can be accomplished with MINERVA's unique combination of high precision and high cadence over long time periods. In this work, we detail changes to the MINERVA facility that have occurred since our previous paper. We then describe MINERVA's robotic control software, the process by which we perform 1D spectral extraction, and our forward modeling Doppler pipeline. In the process of improving our forward modeling procedure, we found that our spectrograph's intrinsic instrumental profile is stable for at least nine months. Because of that, we characterized our instrumental profile with a time-independent, cubic spline function based on the profile in the cross dispersion direction, with which we achieved a radial velocity precision similar to using a conventional "sum-of-Gaussians" instrumental profile: 1.8 m s$^{-1}$ over 1.5 months on the RV standard star HD 122064. Therefore, we conclude that the instrumental profile need not be perfectly accurate as long as it is stable. In addition, we observed 51 Peg and our results are consistent with the literature, confirming our spectrograph and Doppler pipeline are producing accurate and precise radial velocities.Comment: 22 pages, 9 figures, submitted to PASP, Peer-Reviewed and Accepte

Predictors of Increasing Injury Severity across Suspected Recurrent Episodes of Non-Accidental Trauma

Background Little is known about how the severity of injury changes with recurrent events of suspected non-accidental trauma (NAT). Our objective was to determine risk factors for escalating severity of injury in children with multiple events of suspected NAT. Methods This retrospective longitudinal cohort study included children from a pediatric Medicaid accountable care organization with ≥ 1 non-birth related episode containing an International Classification of Diseases, Ninth Revision, Clinical Modification or Current Procedural Terminology code for NAT or a skeletal survey between 2007 and 2011. Subsequent potential NAT events were defined as independent episodes with codes for either NAT, a skeletal survey, or injuries suspicious for abuse. Severity of injury was calculated using the New Injury Severity Score (NISS). Multivariable Cox proportional hazards regression modeling was used with results expressed as hazard ratios and 95 % confidence intervals. Results Of the 914 children with at least one suspected NAT event, 39 % had at least one suspected recurrent NAT event; 12 % had 2 events and 5 % had ≥ 3 events during follow-up. Factors associated with an increased risk for a recurrent episode of suspected NAT with higher NISS were living in a rural area (1.69, 1.02–2.78, p = 0.04) and having an open wound (2.12, 1.24–3.62, p = 0.006), or superficial injury (2.28, 1.31–3.98, p = 0.004). In contrast, a greater number of injuries was associated with a decreased risk for a recurrent episode of suspected NAT with higher NISS (p \u3c 0.0001). Conclusions Though limited by a lack of follow-up of children placed in out of home care, our results suggest that children with “minor” or less numerous injuries are either not reported to child protective services or not removed from the unsafe environment with either situation leading to subsequent events. The medical and child welfare systems need to better identify these potential victims of recurrent events

Predictors of Increasing Injury Severity across Suspected Recurrent Episodes of Non-Accidental Trauma

Background Little is known about how the severity of injury changes with recurrent events of suspected non-accidental trauma (NAT). Our objective was to determine risk factors for escalating severity of injury in children with multiple events of suspected NAT. Methods This retrospective longitudinal cohort study included children from a pediatric Medicaid accountable care organization with ≥ 1 non-birth related episode containing an International Classification of Diseases, Ninth Revision, Clinical Modification or Current Procedural Terminology code for NAT or a skeletal survey between 2007 and 2011. Subsequent potential NAT events were defined as independent episodes with codes for either NAT, a skeletal survey, or injuries suspicious for abuse. Severity of injury was calculated using the New Injury Severity Score (NISS). Multivariable Cox proportional hazards regression modeling was used with results expressed as hazard ratios and 95 % confidence intervals. Results Of the 914 children with at least one suspected NAT event, 39 % had at least one suspected recurrent NAT event; 12 % had 2 events and 5 % had ≥ 3 events during follow-up. Factors associated with an increased risk for a recurrent episode of suspected NAT with higher NISS were living in a rural area (1.69, 1.02–2.78, p = 0.04) and having an open wound (2.12, 1.24–3.62, p = 0.006), or superficial injury (2.28, 1.31–3.98, p = 0.004). In contrast, a greater number of injuries was associated with a decreased risk for a recurrent episode of suspected NAT with higher NISS (p \u3c 0.0001). Conclusions Though limited by a lack of follow-up of children placed in out of home care, our results suggest that children with “minor” or less numerous injuries are either not reported to child protective services or not removed from the unsafe environment with either situation leading to subsequent events. The medical and child welfare systems need to better identify these potential victims of recurrent events