Apparent Life-threatening Event or Child Abuse?

Waseem, Muhammad; Pinkert, Heidi

doi:10.1097/01.pec.0000210176.48386.ae

Cited by 12 publications

(5 citation statements)

References 16 publications

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“…The relationship between ALTEs and child abuse is well documented, and the literature suggests that up to 10% of ALTEs may be attributable to abuse. [22][23][24][25] We caution, however, against making recommendations for changes in clinical practice on the basis of our findings; although the rate of positive SS results in this population was higher than expected, the proportion of children with ALTEs who underwent an SS was small. During the same 4-year time period as in the current study, 421 children were discharged from our ED with a diagnosis of ALTE.…”

Section: Figurecontrasting

confidence: 62%

Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

et al. 2011

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This is the largest study to date to describe the use of the SS. Almost 11% of SS results were positive. The SS results influenced directly the decision to make a diagnosis of abuse for 50% of children with positive SS results. These data, combined with the high morbidity rates for missed abuse and the large proportion of children with healing fractures detected through SS, suggest that broader use of SS, particularly for high-risk populations, may be warranted.

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Section: Figurecontrasting

confidence: 62%

Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

et al. 2011

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“…Younger children can be more easily irritated, are hard to appease, and are relatively unable to defend themselves, fight back, or report their injury. [7–9] This may explain the lower mean age in the abuse group than that in the neglect group. In addition, there were more boys than girls in this study, which is similar to previous studies.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and clinical analysis of critical patients with child maltreatment admitted to the intensive care units

et al. 2017

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Children with abuse who are admitted to the intensive care unit (ICU) may have high mortality and morbidity and commonly require critical care immediately. It is important to understand the epidemiology and clinical characteristics of these critical cases of child maltreatment.We retrospectively evaluated the data for 355 children with maltreatments admitted to the ICU between 2001 and 2015. Clinical factors were analyzed and compared between the abuse and the neglect groups, including age, gender, season of admission, identifying settings, injury severity score (ISS), etiologies, length of stay (LOS) in the ICU, clinical outcomes, and mortality. In addition, neurologic assessments were conducted with the Pediatric Cerebral Performance Category (PCPC) scale.The most common type of child maltreatments was neglect (n = 259), followed by physical abuse (n = 96). The mean age of the abuse group was less than that of the neglect group (P < .05). Infants accounted for the majority of the abuse group, and the most common etiology of abuse was injury of the central nervous system (CNS). In the neglect group, most were of the preschool age and the most common etiologies of abuse were injury of the CNS and musculoskeletal system (P < .001). The mortality rate in the ICU was 9.86%. The ISS was significantly associated with mortality in both the 2 groups (both P < .05), whereas the LOS in the ICU and injuries of the CNS, musculoskeletal system, and respiratory system were all associated with mortality in the neglect group (all P < .05). The PCPC scale showed poor prognosis in the abuse group as compared to the neglect group (P < .01).In the ICU, children in the abuse group had younger age, higher ISS, and worse neurologic outcome than those in the neglect group. The ISS was a predictor for mortality in the abuse and neglect groups but the LOS in the ICUs, injuries of the CNS, musculoskeletal system, and respiratory system were indicators for mortality in the neglect group. Most importantly, identifying the epidemiological information may provide further strategies to reduce the harm, lower the medical costs, and improve clinical care quality and outcomes in children with abuse.

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“…A study conducted in Denver involving children who died of AHT found that the most common presenting complaint was apnea; only 1 of 36 had a presenting complaint of trauma (Graupman & Winston, 2006). In Vellody's study of infants with a history of ALTE (Duhaime et al, 1992), 4 of 108 infants were eventually found to have sustained AHT (Waseem & Pinkert, 2006). All four had other findings suspicious for abuse including skin contusions, fractures, retinal hemorrhages, or a history given by a parent that the infant had been shaken.…”

Section: Clinical Presentationmentioning

confidence: 96%