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RESEARCH PRODUCT

Proposal of an exploitation method of a national database, the PMSI, to estimate the frequency of the abused children in France, from 0 to 5 years old, their lethality and the characteristics of their hospital stays

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Importance: Childhood abuse is a global public health issue yet there is a serious lack of reliable epidemiological data and the figures reported are very often underestimated. A large part of these children are not diagnosed. Moreover, diagnosed children are not recorded in a single database.Objective: The aim of this study is to provide two estimations of the frequency of child physical abuse requiring hospitalization (hospital prevalence) and the corresponding in-hospital fatality. Design, setting and participants: This was a national retrospective study using a national hospital database (PMSI).We included all children aged less than 2 years old hospitalized at least once in France from 2007 to 2014. Infants less than 1 month old were excluded in order to exclude all pathologies and neonatal complications.Three groups were defined: group1 - physically abused children (identified by the ICD 10 codes used in the PMSI concerning physical abuse); group2 - possible physically abused children (suspicious physical injuries associated with child maltreatment); and group3 - all other hospitalized children (the control group).Main outcomes and measurements: First, based on the number of children aged 0 to 2 years in France in 2010, we provide two estimations of the frequency of child physical abuse requiring hospitalization (hospital prevalence): a lower bound represented by the children of group 1 and an upper bound represented by the children of group 1+2.Secondly, we studied the follow-up of these children from their inclusion to 2014, thanks to the linkage of the differents hospital stays; with regard to the number of hospitalizations, their length of stay, their reasons and in-hospital fatality.Results: In our study, 2,628,386 children were included: 4,172 in group1, 12,024 in group2 and 2,612,190 in group3. The national annual hospital prevalence of child physical abuse (and hospital fatality) in children aged 0 to 2 years ranged from 1.6‰ (2.52%) to 5.7‰ (2.01%). Most hospital deaths occurred during the first hospital stay (between 99% and 99.6%) and are 10 times higher than in the control group. The length of stay of abused children is up to 5 times longer than for other children. Conclusions and relevance: To our knowledge, this is the first study to provide an estimation of the frequency of child physical abuse requiring hospitalization and the corresponding in-hospital fatality. Three out of four children may not be identified as being maltreated and are at risk of recurrent abuses. More effective prevention should be implemented by health professionals in order to identify those children.