{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:02:25Z","timestamp":1789621345119,"version":"build-2803163510"},"reference-count":43,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Pediatric forensic cases represent a growing public health concern and impose substantial burdens on emergency departments (EDs). However, data on operational predictors of ED length of stay (ED-LOS) in this specific population remain limited. We aimed to identify predictors of increased ED length of stay (ED-LOS) and evaluate clinical profiles of pediatric forensic cases. Methods: This retrospective observational study included 1113 pediatric forensic cases. Cox proportional hazards regression was used as the primary method to identify predictors of time-to-discharge. Firth\u2019s penalized logistic regression and Random Forest (RF) were used for binary prediction based on a data-derived 45 min high-acuity threshold established via Reciever Operating Characteristic (ROC) analysis. Performance was assessed via AUC, Brier score, bootstrap validation, and Decision Curve Analysis (DCA). Results: The cohort was predominantly adolescent (71.5%) and male (65.3%), with interpersonal assault (36.7%) and standard forensic examinations (26.7%) being the most frequent etiologies. In the Cox regression, lower clinical acuity (higher Emergency Severity Index [ESI] scores) significantly increased the hazard of discharge (Hazard Ratio [HR]: 1.954). Conversely, specific trauma mechanisms notably delayed discharge, particularly intoxication (HR: 0.126), burns (HR: 0.127), and out-of-vehicle traffic accidents (HR: 0.237). Parent-accompanied presentation was independently associated with faster ED processing (HR: 1.303), while ambulance arrival was not a significant independent driver of overall time-to-discharge (p = 0.176). RF confirmed that the ESI was the dominant operational predictor (37.0% importance; test AUC 0.906), and the Firth regression demonstrated that these same mechanisms were the strongest predictors. The model showed high Negative Predictive Value (96.9%) and DCA benefit. Conclusions: This study proposes a framework for predicting increased ED-LOS in pediatric forensic cases. Cox regression suggested that ESI and trauma mechanisms modulate discharge speed, reflecting operational patterns. The findings may support triage stratification and resource allocation, but external validation is needed.<\/jats:p>","DOI":"10.3390\/jcm15187110","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:09:51Z","timestamp":1789387791000},"page":"7110","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Triage Acuity and Injury Mechanisms as Drivers of Emergency Department Length of Stay in Pediatric Forensic Cases"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4670-2476","authenticated-orcid":false,"given":"Muhammet Ra\u015fit","family":"\u00d6zer","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Department of Emergency Medicine, Karamano\u011flu Mehmetbey University, 70100 Karaman, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6177-710X","authenticated-orcid":false,"given":"\u00d6mer","family":"Jaradat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Emergency Medicine, Necmettin Erbakan University, 42080 Konya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadir","family":"K\u00fc\u00e7\u00fckceran","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Emergency Medicine, Necmettin Erbakan University, 42080 Konya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7019-1012","authenticated-orcid":false,"given":"Ali","family":"Avc\u0131","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Karaman Training and Research Hospital, 70200 Karaman, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.jen.2020.02.009","article-title":"A Retrospective Records-Based Cohort of 1,082 Pediatric Forensic Cases Presenting to the Emergency Department","volume":"46","author":"Taplak","year":"2020","journal-title":"J. Emerg. Nurs."},{"key":"ref_2","unstructured":"World Health Organization (2026, May 26). Global Status Report on Preventing Violence Against Children 2020. Available online: https:\/\/www.who.int\/teams\/social-determinants-of-health\/violence-prevention\/global-status-report-on-violence-against-children-2020."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e20154079","DOI":"10.1542\/peds.2015-4079","article-title":"Global Prevalence of Past-Year Violence Against Children: A Systematic Review and Minimum Estimates","volume":"137","author":"Hillis","year":"2016","journal-title":"Pediatrics"},{"key":"ref_4","unstructured":"Turkish Statistical Institute (2026, May 26). Statistics on Children 2023, Available online: https:\/\/data.tuik.gov.tr\/Bulten\/Index?p=Istatistiklerle-Cocuk-2023-53679."},{"key":"ref_5","unstructured":"United Nations Children\u2019s Fund (2017). A Familiar Face: Violence in the Lives of Children and Adolescents, UNICEF."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"130","DOI":"10.4103\/2452-2473.348432","article-title":"Evaluation of Forensic Cases Presented to the Pediatric Emergency Department","volume":"22","author":"Arslan","year":"2022","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_7","first-page":"122","article-title":"Evaluation of Forensic Cases in the Pediatric Intensive Care Unit","volume":"55","author":"Polat","year":"2021","journal-title":"Med. Bull. Sisli Etfal Hosp."},{"key":"ref_8","first-page":"20","article-title":"Evaluation of Pediatric Forensic Cases Admitted to the Emergency Department in Turkey: A Retrospective Analysis","volume":"17","author":"Alemdar","year":"2021","journal-title":"J. Forensic Nurs."},{"key":"ref_9","unstructured":"Gilboy, N., Tanabe, P., Travers, D., and Rosenau, A.M. (2012). Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook, 2012 Edition, Agency for Healthcare Research and Quality. AHRQ Publication No. 12-0014."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"g7594","DOI":"10.1136\/bmj.g7594","article-title":"Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD Statement","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"116","DOI":"10.47572\/muskutd.644086","article-title":"The Evaluation of Pediatric Patients with Forensic Reports in a Forensic Medicine Out Patient Clinic","volume":"7","author":"Ersoy","year":"2020","journal-title":"MMJ"},{"key":"ref_13","unstructured":"Ko\u00e7, S., and Can, M. (2011). Forensic Medicine in Primary Care [Birinci Basamakta Adli T\u0131p], Istanbul Medical Chamber. [2nd ed.]. Available online: https:\/\/www.istabip.org.tr\/dosyalar\/adli_tip.pdf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"384","DOI":"10.36472\/msd.v11i11.1227","article-title":"Evaluation of the Procedure and Content of Forensic Reports Issued for Judicial Cases in Emergency Departments","volume":"11","author":"Uygun","year":"2024","journal-title":"Med. Sci. Discov."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1001\/jamapediatrics.2024.2671","article-title":"Emergency Severity Index Version 4 and Triage of Pediatric Emergency Department Patients","volume":"178","author":"Sax","year":"2024","journal-title":"JAMA Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A Solution to the Problem of Separation in Logistic Regression","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat. Med."},{"key":"ref_17","first-page":"9","article-title":"Analysis of Patients Evaluated Forensically in the Emergency Department and the Burden of Assault and Force Examinations on the Emergency Department","volume":"6","author":"Alpaslan","year":"2025","journal-title":"J. Med. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4274\/cayd.galenos.2021.55265","article-title":"Forensic Cases in Pediatric Emergency Department: A Single Center Experience","volume":"9","author":"Esen","year":"2022","journal-title":"J. Pediatr. Emerg. Intensive Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"75","DOI":"10.5603\/DEMJ.2018.0018","article-title":"The Evaluation of Pediatric Forensic Cases Presented to Emergency Department","volume":"3","author":"Demirel","year":"2018","journal-title":"Disaster Emerg. Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"384","DOI":"10.26453\/otjhs.1052904","article-title":"Characteristics of Pediatric Forensic Cases Caused by Blunt General Body Trauma Evaluated in the Emergency Department: A Single Center Experience","volume":"7","author":"Demirel","year":"2022","journal-title":"OTJHS"},{"key":"ref_21","first-page":"111","article-title":"Evaluation of Forensic Cases Admitted to the Pediatric Emergency Department","volume":"6","author":"Bolat","year":"2023","journal-title":"J. Health Sci. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00417-015-3199-4","article-title":"Severe Cranial Neuropathies Caused by Falls from Heights in Children","volume":"254","author":"Zahavi","year":"2016","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_23","first-page":"1","article-title":"Pediatric Forensic Cases: An Emergency Department Experience","volume":"32","year":"2018","journal-title":"Turk. J. Forensic Med."},{"key":"ref_24","first-page":"668","article-title":"Trauma and Intentional Injury Characteristics of Pediatric Forensic Cases Applying to Emergency Room","volume":"7","author":"Kalkan","year":"2016","journal-title":"J. Clin. Anal. Med."},{"key":"ref_25","unstructured":"Centers for Disease Control and Prevention (2026, May 27). Web-Based Injury Statistics Query and Reporting System (WISQARS), Available online: https:\/\/www.cdc.gov\/injury\/wisqars\/index.html."},{"key":"ref_26","unstructured":"World Health Organization (2015). The Global Strategy for Women\u2019s, Children\u2019s and Adolescents\u2019 Health (2016\u20132030): Survive, Thrive, Transform, WHO. Available online: https:\/\/www.everywomaneverychild.org\/wp-content\/uploads\/2017\/10\/EWEC_GSUpdate_Brochure_EN_2017_web.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1097\/JS9.0000000000001131","article-title":"Global Burden of All Cause-Specific Injuries Among Children and Adolescents from 1990 to 2019: A Prospective Cohort Study","volume":"110","author":"Li","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_28","unstructured":"Centers for Disease Control and Prevention (2026, May 27). Data and Statistics (WISQARS): Injury Reports, Available online: https:\/\/wisqars.cdc.gov:8443\/costT\/."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"107","DOI":"10.26453\/otjhs.1723521","article-title":"Six-Year Analysis of Forensic Cases in the Emergency Department of a City Hospital: Demographic and Clinical Findings","volume":"11","year":"2026","journal-title":"OTJHS"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Carannante, A., Giustini, M., Rota, F., Bailo, P., Piccinini, A., Izzo, G., Bollati, V., and Gaudi, S. (2025). Intimate Partner Violence and Stress-Related Disorders: From Epigenomics to Resilience. Front. Glob. Womens Health, 6.","DOI":"10.3389\/fgwh.2025.1536169"},{"key":"ref_31","unstructured":"UNICEF (2026, September 07). FAST FACTS: Violence Against Children Widespread, Affecting Millions Globally. Available online: https:\/\/www.unicef.org\/turkiye\/en\/press-releases\/fast-facts-violence-against-children-widespread-affecting-millions-globally."},{"key":"ref_32","unstructured":"UNICEF (2026, September 07). Two Thirds of Children Across Europe and Central Asia Experience Violent Discipline at Home, a Third Are Physically Punished. Available online: https:\/\/www.unicef.org\/turkiye\/en\/press-releases\/two-thirds-children-across-europe-and-central-asia-experience-violent-discipline."},{"key":"ref_33","unstructured":"U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children\u2019s Bureau (2026, September 07). Child Maltreatment 2024, Available online: https:\/\/acf.gov\/cb\/data-research\/child-maltreatment."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Hughes Garza, H., Piper, K.E., and Lawson, K.A. (2026). Physical Abuse of Young Children Reported by Medical Professionals in the United States 2014\u20132023. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1718486"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"271","DOI":"10.4274\/haseki.1712","article-title":"Evaluation of Pediatric Forensic Cases in Emergency Department: A Retrospective Study","volume":"52","author":"Korkmaz","year":"2014","journal-title":"Med. Bull. Haseki"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1111\/j.1553-2712.2009.00494.x","article-title":"Reliability and Validity of the Emergency Severity Index for Pediatric Triage","volume":"16","author":"Travers","year":"2009","journal-title":"Acad. Emerg. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1097\/PEC.0b013e3182621813","article-title":"Emergency Severity Index Version 4: A Valid and Reliable Tool in Pediatric Emergency Department Triage","volume":"28","author":"Green","year":"2012","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jen.2023.11.009","article-title":"Triage Accuracy in Pediatrics Using the Emergency Severity Index","volume":"50","author":"Frankenberger","year":"2024","journal-title":"J. Emerg. Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1038\/s41390-020-01237-0","article-title":"Prolonged Hospital Length of Stay in Pediatric Trauma: A Model for Targeted Interventions","volume":"90","author":"Gibbs","year":"2021","journal-title":"Pediatr. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S316","DOI":"10.1093\/jbcr\/iraf019.415","article-title":"Factors Influencing Emergency Department Length of Stay in Pediatric Burn Patients","volume":"46","author":"Kumar","year":"2025","journal-title":"J. Burn Care Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1337","DOI":"10.1542\/peds.2015-0356","article-title":"The Evaluation of Suspected Child Physical Abuse","volume":"135","author":"Christian","year":"2015","journal-title":"Pediatrics"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Pepele, M.S., Derya, S., Murat, M., Akdemir, A., and Y\u00fccel, N. (2026). Pediatric Trauma in the Emergency Department: Clinical Risk Stratification, CT Utilization and Radiation Burden in a Tertiary Care Cohort. J. Clin. Med., 15.","DOI":"10.3390\/jcm15041470"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Ayg\u00fcn, E., \u0130mdat, A., and Dalg\u0131\u00e7, N. (2026). Should We Leave Paediatric Emergency Triage to Artificial Intelligence? A Comparison of ChatGPT 4o and Grok 3. Front. Pediatr., 14.","DOI":"10.3389\/fped.2026.1739217"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7110\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:14:57Z","timestamp":1789618497000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,13]]},"references-count":43,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187110"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187110","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,13]]}}}