Children admitted to paediatric intensive care at Red Cross War Memorial Children's Hospital with non-accidental injuries (2012 - 2020): A retrospective descriptive study.

Background: Violence against children remains common in South Africa (SA). Children sustaining severe non-accidental injuries (NAIs) may require admission to paediatric intensive care units (PICUs), however, their outcomes have not been well described in SA. Objectives: To describe the characteristics and outcomes of patients admitted to the PICU with suspected NAIs at Red Cross War Memorial Children's Hospital (RCWMCH). Methods: A retrospective descriptive study of routinely collected data from all children admitted to the PICU at RCWMCH with suspected NAIs from 1 January 2012 to 31 December 2020. Results: Of 11 345 children admitted to the PICU, 42 (0.4%) patients with suspected NAI (median (IQR) age 20.3 (7.9 - 62.6) months; 61.9% male) were included in data analysis. Most patients sustained physical injury (n=35; 83.3%) from assaults (n=19; 45.2%), and head injuries were the most common injury site, while 37 (88.1%) received invasive mechanical ventilation for a median (interquartile range) of 2.0 (1.0 - 3.8) days. PICU mortality was 28.6% (n=12), with a risk-adjusted mortality (observed/mean predicted mortality) of 3.6. Of the 30 PICU survivors, 7 (23.3%) were discharged with long-term disability, while the functional outcome of 16 (53.3%) survivors remains unknown. Conclusion: Children who have sustained NAI represent a small proportion of PICU admissions, with high mortality and considerable morbidity. Contribution of the study: Children with severe non-accidental injury (NAI) represent fewer than 0.5% of paediatric intensive care unit (PICU) admissions at Red Cross War Memorial Children's Hospital over a nine-year period. PICU mortality was 28.6%, more than double the general PICU mortality rate, with a risk adjusted mortality nearly four times the predicted rate. Head injury was the most common and most fatal injury pattern; most incidents occurred in the home, and the perpetrator was most often a family member. Nearly a quarter of survivors were discharged with long-term disability. These findings highlight the need for early clinical recognition of NAI, strict compliance with mandatory reporting obligations, and structured interdisciplinary follow-up of survivors.