• Jonathan D Thackeray, Kristin G Crichton, Paul McPherson, Eugene Izsak, Lori Vavul-Roediger, Grace Kim, Sandra Spencer, Carrie Baker, Emily A Eismann, Robert A Shapiro, and TRAIN Collaborative.
• From the Department of Pediatrics, Division of Child Advocacy, Dayton Children's Hospital, Dayton.
• Pediatr Emerg Care. 2022 Jun 1; 38 (6): e1279e1284e1279-e1284.

MethodsSix children's hospitals identified infants with an initial injury and recurrent injury over a 1-year period using 2 methods: (1) diagnostic code method - infants 6 months or younger presenting with at least 1 diagnostic code for injury were tracked for 12 months to determine the frequency of recurrent injury, and (2) consult method - all available medical records of children 18 months or younger seen for an inpatient consultation for suspected child abuse were reviewed to identify history of a first injury at 6 months or younger.ResultsUsing the diagnostic code method, 682 unique infants were identified with initial injuries, most commonly fractures (37.0%), bruising/ecchymosis (35.9%), and superficial injuries (28.3%). Forty-two infants (6.2%) returned with a second injury, and no demographic factors were significantly associated with the likelihood of a second injury. Using the consult method, 37 of 342 consults (10.8%) were identified as having a history of at least 1 initial injury. Of the initial injuries identified, the most common was bruising/ecchymosis (64.9%). The number of injuries identified with either method varied significantly across hospitals, as did completion of skeletal surveys for infants with bruising (range, 4.5%-71.1%; P < 0.001) and any injury (range, 4.4%-62.7%; P < 0.001).ConclusionsOur study demonstrates that young infants who experience 1 injury often experience a second injury. There exists significant variability in the identification of injury and the completion of skeletal surveys across a network of 6 children's hospitals. A standardized quality improvement approach may improve identification of injury and reduce the variability in practice observed.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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