Bruising Characteristics Discriminating Physical Child Abuse From Accidental Trauma

Pierce, Mary Clyde; Kaczor, Kim; Aldridge, Sara; O'Flynn, Justine; Lorenz, D.

doi:10.1542/peds.2008-3632

Cited by 251 publications

(170 citation statements)

References 27 publications

(29 reference statements)

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“…75 There is ample evidence that evaluating bruising patterns in abused and nonabused children helps to identify specific ages, locations, and patterns of bruising that are highly correlated with child abuse. [76][77][78][79][80][81] In children with bruising related to normal activity, the prevalence and mean number of bruises increases with age, and the majority of preschool-aged and schoolchildren have accidental bruises. 82 The commonest sites of bruising in nonabused, ambulatory children are to the knees and shins, and the vast majority of normal bruises are over bony prominences, including the forehead.…”

Section: Skin Injuriesmentioning

confidence: 99%

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The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

450

301

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Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.

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Section: Skin Injuriesmentioning

confidence: 99%

“…78 All parts of the body are vulnerable to bruising from abuse, and bruises to the torso, ears, or neck in children #4 years of age are predictive of abuse. 76 The mnemonic "TEN 4" is an easy way to identify bruises that are of concern for abuse:…”

Section: Skin Injuriesmentioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

450

301

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“…103,104 Bruising in a child who is not yet cruising or bruising in unusual locations, such as the ears, neck, or trunk should raise suspicion for child abuse. 105,106 The child should be examined for other injuries caused by child abuse, in addition to signs of other medical conditions associated with bone fragility. Blue sclerae are seen in certain types of OI.…”

Section: Physical Examinationmentioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

247

162

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Fractures are common injuries caused by child abuse. Although the consequences of failing to diagnose an abusive injury in a child can be grave, incorrectly diagnosing child abuse in a child whose fractures have another etiology can be distressing for a family. The aim of this report is to review recent advances in the understanding of fracture specificity, the mechanism of fractures, and other medical diseases that predispose to fractures in infants and children. This clinical report will aid physicians in developing an evidence-based differential diagnosis and performing the appropriate evaluation when assessing a child with fractures. Pediatrics 2014;133:e477-e489 INTRODUCTIONFractures are the second most common injury caused by child physical abuse; bruises are the most common injury. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 2-4 Physical abuse may not be considered in the physician' s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted. 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family. To identify child abuse as the cause of fractures, the physician must take into consideration the history, the age of the child, the location and type of fracture, the mechanism that causes the particular type of fracture, and the presence of other injuries while also considering other possible causes. DIFFERENTIAL DIAGNOSIS OF FRACTURES Trauma: Child Abuse Versus Noninflicted InjuriesFractures are a common childhood injury and account for between 8% and 12% of all pediatric injuries. [6][7][8] In infants and toddlers, physical FROM THE AMERICAN ACADEMY OF PEDIATRICSGuidance for the Clinician in Rendering Pediatric Care by guest on May 11, 2018 http://pediatrics.aappublications.org/ Downloaded from abuse is the cause of 12% to 20% of fractures. 9 Although unintentional fractures are much more common than fractures caused by child abuse, the physician needs to remain aware of the possibility of inflicted injury. Although some fracture types are highly suggestive of physical abuse, no pattern can exclude child abuse. 10,11 Specifically, it is important to recognize that any fracture, even fractures that are commonly noninflicted injuries, can be caused by child abuse. Certain details that can help the physician determine whether a fracture was caused by abuse rather than unintentional injury include the hist...

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“…14,15 Several studies have identified characteristics of bruises associated with abusive versus accidental injury, but clear guidelines for clinicians regarding when to perform an initial SS for abuse in young children with bruising have not been developed. 1,16 Accordingly, the goal of this study was to develop guidelines for performing initial SS in children ,2 years old presenting with bruising. This set of guidelines focuses on children presenting for care in a hospitalbased setting, primarily the emergency department or the inpatient unit, and may not be applicable to children presenting in the primary care setting.…”

Section: What This Study Addsmentioning

confidence: 99%

Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises

2015

PEDIATRICS

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OBJECTIVE: To develop guidelines for performing an initial skeletal survey (SS) for children ,24 months of age presenting with bruising in the hospital setting, combining available evidence with expert opinion. METHODS:Applying the Rand/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children ,24 months old with bruising. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 219 revised scenarios. For the 136 clinical scenarios in which SS was deemed appropriate, the panel finally assessed the necessity of SS.RESULTS: Panelists agreed that SS is "appropriate" for 62% (136/219) of scenarios, and "inappropriate" for children $12 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is "necessary" for 95% (129/136) of the appropriate scenarios. SS was deemed necessary for infants ,6 months old regardless of bruise location, with rare exceptions, but the necessity of SS in older children depends on bruise location. According to the panelists, bruising on the cheek, eye area, ear, neck, upper arm, upper leg, hand, foot, torso, buttock, or genital area necessitates SS in children ,12 months. CONCLUSIONS:The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising. WHAT'S KNOWN ON THIS SUBJECT:Bruising is common in young victims of physical abuse as well as in cases of accidental trauma. There is uncertainty regarding which young children with bruising require evaluation with skeletal survey for possible abuse. WHAT THIS STUDY ADDS:The results of this study provide guidelines, based on the literature and knowledge of experts, for identifying children ,24 months presenting for care in the hospital setting with bruises, who should and should not undergo skeletal survey.

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Bruising Characteristics Discriminating Physical Child Abuse From Accidental Trauma

Abstract: Discriminating differences exist in bruising characteristics for abusive versus accidental trauma. The body region- and age-based bruising clinical decision rule model functions as a clinically sensible screening tool to identify young children who require further evaluation for abuse.

Cited by 251 publications

References 27 publications

The Evaluation of Suspected Child Physical Abuse

The Evaluation of Suspected Child Physical Abuse

Evaluating Children With Fractures for Child Physical Abuse

Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises

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