LAUSR

I n the trauma bay, let’s call “non-accidental trauma” (NAT) what it is: blunt force trauma. To be even more accurate, we should call it blunt force trauma or assault secondary to child physical abuse, with or without neglect. Although the use of the term NAT seems like an attempt to avoid presumptively or falsely accusing caretakers of abuse, its vagueness neglects recognition of the underlying mechanism of action, and the negative prefix (“non”) may downplay the serious of the offense. Although primarily an issue of semantics, we must be more precise and accurate in our initial description of this diagnosis and the underlying implications about the mechanism to ensure injured children have access to the best care possible. What started as “battered child syndrome” in 1962 was edited to “child abuse,” and then “non-accidental injuries” and “non-accidental trauma” in the early 1970s. “Abusive head trauma” also emerged in the mid-1990s as an alternative term to “shaken baby syndrome,” recognizing that this pattern of injury in infants may be caused by both impact and/or sheer forces from shaking. Most clinicians seem to currently use the term “child abuse.” However, the term NAT has persisted in our medical lexicon and seems more prevalent among surgeons and within the surgical literature. A search for the term “child abuse” in the title of articles listed in PubMed comes up with over 4,100 hits from a variety of journals, including the journal, Child Abuse & Neglect, whereas a search for the term “non-accidental trauma” results in 95 hits, with a high proportion of articles published in pediatric surgery and radiology journals. Shouldn’t we agree on one term? Strictly speaking, NAT could refer to adults or children in a variety of situations. For example, it could refer to an adult assaulted in a bar, a teenager shot in a drive-by shooting, or an elderly patient in a motor vehicle collision secondary to a suicide attempt. In none of these situations was the trauma “accidental.” Yet NAT is almost exclusively used to describe blunt force trauma in children secondary to assault or abuse. In the acute setting, does the accidental (or non-accidental) nature of the assault—which is typically only determined after a careful investigation by trained professionals and law enforcement— truly matter in the triage and emergency treatment of injured children? Instead, we should use terms to more clearly identify