Additional Injuries in Young Infants with Concern for Abuse and Apparently Isolated Bruises

Harper, Nancy S.; Feldman, Kenneth W.; Sugar, Naomi F.; Anderst, James D.; Lindberg, Daniel M.

doi:10.1016/j.jpeds.2014.04.004

Cited by 72 publications

(49 citation statements)

References 38 publications

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“…These findings include bruising, subconjunctival hemorrhage, bleeding from the nose or mouth, and a history of rapid head enlargement or head circumference >95th percentile. 67,[70][71][72][73][74] It is important to perform a careful physical examination to identify subtle findings of child abuse, including a large or full/bulging anterior fontanel, scalp bruising or bogginess, oropharynx or frenula damage, or skin findings such as bruising or petechiae, especially on the trunk, face, or ears. A normal physical examination does not rule out the possibility of abusive head trauma.…”

Section: E Clinicians Should Not Obtain Anmentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

138

154

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This is the fi rst clinical practice guideline from the American Academy of Pediatrics that specifi cally applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defi ned as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper-or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this defi nition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient-and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefi t-harm relationship, and the strength of recommendation.

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Section: E Clinicians Should Not Obtain Anmentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

138

154

View full text Add to dashboard Cite

show abstract

“…Bruises may be the sole presenting feature of physical abuse 1. The assessment rests on an evaluation of the plausibility of the explanation offered for the injuries seen, largely based on experience 2.…”

Section: Introductionmentioning

confidence: 99%

Childhood bruising distribution observed from eight mechanisms of unintentional injury

et al. 2017

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“…Current published prevalence data come from well-child care clinics, general emergency department (ED) visits that excluded trauma and suspected abuse patients, and from abuse clinics. 2,3,10,11 These data may not apply to PED settings where patients with a full spectrum of medical, surgical, traumatic, and social complaints are examined.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Bruising Among Infants in Pediatric Emergency Departments

Pierce

Magaña

Kaczor

et al. 2016

Annals of Emergency Medicine

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Objective Bruising can indicate abuse for infants. Bruise prevalence among infants in the Pediatric Emergency Department (PED) setting is unknown. Our objective was to determine prevalence of bruising, associated chief complaints (CC), and frequency of abuse evaluations in previously healthy infants presenting to PEDs. Methods We conducted a prospective, observational, multi-center study of infants ≤12 months old presenting to PEDs. Structured sampling was utilized. Pediatric Emergency Medicine (PEM) clinicians performed complete skin examinations to screen for bruising. Study investigators documented skin findings, date of visit, patient's age, CC, and abuse evaluation. The primary outcome was prevalence of bruising. Secondary outcomes were prevalence of bruising based on CC and frequency of abuse evaluation. Point estimates of bruise prevalence and differences in bruise prevalence between patient subgroups were calculated with 95% confidence intervals (CI). Results Bruising was identified in 88 of 2488 infants (3.5%, 95% CI: [2.9%, 4.4%]). Rates of bruising for infants ≤5 and >5 months old were 1.3% and 6.4%, respectively (difference 5.1%, 95% CI: [3.6%, 6.8%]). For infants ≤5 months old, 83% of bruising was associated with a trauma CC and only 0.2% of infants presenting with a medical CC had bruising. PEM clinicians obtained abuse evaluations on 23% of infants with bruising and that rate increased to 50% for infants ≤ 5 months of age. Conclusions Bruising prevalence in children ≤ 12 months of age evaluated in PEDs was low, increased within age strata, and was most often associated with a trauma CC. Most bruised infants did not undergo an abuse evaluation.

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Additional Injuries in Young Infants with Concern for Abuse and Apparently Isolated Bruises

Cited by 72 publications

References 38 publications

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Childhood bruising distribution observed from eight mechanisms of unintentional injury

The Prevalence of Bruising Among Infants in Pediatric Emergency Departments

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