• Vol. 47 No. 10
  • 15 October 2018

Five-Year Review of Patients Presenting with Non- Accidental Injury to a Children’s Emergency Unit in Singapore

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ABSTRACT

There is an increasing trend of physical child abuse cases reported in Singapore. Children presenting to the Emergency Department with injuries require a high index of suspicion for clinicians to distinguish those that are abusive in nature. Materials and Methods: A retrospective study of children with diagnosis of NAI presenting to KK Women’s and Children’s Hospital (KKH) from June 2011 to May 2016 was conducted. Results: There were 1917 cases reported from 1730 subjects, of which: 8.8% of subjects had repeat visits; 55.2% of cases were male; and mean age was 7.69 years. Racial demographics were: Chinese 45.5%, Malay 33.4%, Indian 15.4% and Others 5.9%. The most frequent injuries sustained were head and neck (50.8%), limbs (32.2%), and chest (5.7%). Of the type of injuries, 55% had contusions, 21% had cane marks, 16% had lacerations, 4.4% had burn marks and 1% sustained fractures. Males were more likely to be caned (P <0.001); 54.9% of cases were admitted and 38.9% were discharged. Cases that presented without a parent (P <0.001), were known to Child Protective Service (P <0.001), or had a history of parental substance abuse (P = 0.038), mental illness in caregiver (P = 0.021), or domestic violence (P <0.001) were more likely to require admission. Conclusion: Analysing these factors provide a better understanding of the presentation of NAI cases, including 'red flags' and vulnerable groups who should have better protection.


Physical abuse constitutes 60% of child maltreatment. In Singapore, the Child Protective Service of the Ministry of Social and Family Development (MSF) has reported an increasing trend of physical abuse cases (confirmed by their child abuse investigations) from 117 in 2012 to 263 in 2015.

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