Peer-reviewed article

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

Bowes L, Rossouw B, Morrow BM · 23 Apr 2026

Abstract

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.