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Infants who suffer an apparent life-threatening event are at risk for subsequent child abuse and adverse neurological outcomes. Deaths were uncommon and only occurred in the setting of severe developmental delay and seizure disorders. Neurological evaluation during hospitalization for a first apparent life-threatening event is of low yield, but close follow-up is essential.

Routine PMI screening is conducted infrequently by most PEM physicians. Improved physician education/training and the development of a validated ED-specific mental health screening tool would assist PEM physicians in the early detection of PMI.

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The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.

Objective-To examine whether pre-abuse rates and patterns of emergency department (ED) visits between children with supported child abuse and age-matched controls are useful markers for abuse risk.Study design-A population-based case-control study using probabilistic linkage of four statewide data sets. Cases were abused children <13 years, identified between 1/1/01-12/31/02. For each case, a birth date matched population-based control was obtained. Outcome measures were rate ratios of ED visits in cases compared with controls.Results-9795 cases and 9795 controls met inclusion criteria. 4574 cases (47%) had an ED visit; thus linked to the ED database versus 2647 controls (27%). The crude ED visit rate per 10 000 persondays of exposure was 8.2 visits for cases compared with 3.9 visits for controls. Cases were almost twice as likely as controls (adjusted rate ratio = 1.8, 95% CI:1.5, 1.8) to have had a prior ED visit. Leading ED discharge diagnoses were similar for both groups.Conclusions-Children with supported child abuse have higher ED use prior to abuse diagnosis, when compared with the general pediatric population. However, neither the rate of ED use nor the pattern of diagnoses offers sufficient specificity to be useful markers of risk for abuse.Child abuse is the fourth leading cause of childhood death in the United States.(1) Current evidence suggests that many children who die from child abuse are seen by a health care provider for medical conditions related to abuse prior to the diagnosis, possibly resulting in a missed opportunity for intervention. (2-12) For example, King studied a cohort of fatally abused children and found that almost 20% of the children had documented contact with the health care community for reasons other than routine care within a month before death. (7) Similarly, Jenny et al found that 31% of children with abusive head trauma had been seen by a health care provider prior to recognition of their head injury, with a mean time to correct diagnosis in these children of seven days. (2) Author contact: Elisabeth Guenther, MD, MPH, Associate Professor, Division of Pediatric Emergency Medicine, University of Utah School of Medicine, PO Box 581289, Salt Lake City, Utah 84158, Phone: (801)587-6570, Fax: (801)587-6595, E-mail: elisabeth.guenther@hsc.utah.edu. Edited by TW and WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. These studies suggest that the ED may be a clinical setting where there is an opportunity for earlier identification of both physical and sexual child abuse; 12 however, there is little information on whether abused c...

Initiatives intended to reduce the frequency and impact of medical errors generally rely on recognition and disclosure of medical errors. However, fear of malpractice liability is a barrier to physician disclosure. Some U.S. state legislatures have attempted to encourage physicians to disclose medical errors by enacting "apology laws." The authors reviewed the codified statutes of each of the 50 states and the District of Columbia to determine the prevalence and characteristics of such apology laws. They found that many states have recently adopted apology laws and that there is variability in these laws. The authors review some of the important differences in these laws and explore the potential impact of apology laws.

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