Statement of Purpose Children suffering physical abuse may initially present with minor injuries that are underappreciated, only to suffer more severe injuries in the future. This study evaluated young children presenting to hospitals in the state of Florida, to calculate the incidence of injuries deemed high risk for child physical abuse (HRCPA), characterize presenting hospital types, and identify risk factors for subsequent injury-related hospital admissions.

Methods/Approach All patients 5 years old and younger from the 2009–2014 Florida Agency for Healthcare Administration emergency department and inpatient databases were included. HRCPA was defined based on diagnosis codes previously shown to carry >70% risk of child physical abuse in this age group. Demographics, hospital types, and outcomes were described. Risk factors for subsequent injury-related hospital admission within one year were identified using multivariable logistic regression modeling.

Results Of 77,725 children presenting to hospitals during the 6-year study period, 8,626 (11.1%) met criteria for HRCPA. Only 433 of these HRCPA patients (5.0%) initially presented to pediatric trauma centers; most (68.4%) initially presented to community hospitals. The 1-year incidence of subsequent injury-related admission was 2.9%. After adjustment for covariates, including socioeconomic factors and pre-existing medical comorbidities, initial presentation to a non-pediatric trauma center (community hospital or adult trauma center without pediatric designation) was associated with significantly higher risk for subsequent injury-related admission (odds ratio 1.93, 95% confidence interval 1.34–2.76, p=<0.001).

Significance Since the majority of Florida children with HRCPA initially present to community hospitals rather than designated trauma centers, prevention and education efforts should focus on staff in community hospital settings. Initial evaluation in a pediatric trauma center was a protective factor against subsequent injury-related admission, suggesting stronger collaboration is needed across hospital types to recognize children at risk and prevent future injuries.