Occult Head Injury in High-Risk Abused Children

Self Cite

452

301

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.

Section: Skin Injuriesmentioning

confidence: 99%

“…97,129,137 Infants with intracranial injuries may have no neurologic symptoms and are sometimes identified during a medical evaluation for other suspicious injuries. 75,138 Because the potential morbidity of AHT is so great, infants who are being evaluated for abuse benefit from brain imaging, whether or not they have neurologic symptoms.…”

Section: Head Injuriesmentioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Self Cite

452

301

“…It is not surprising that most scenarios required SS and that SS was not deemed inappropriate for any scenarios, given the high likelihood of abuse and related occult fractures in young children with head trauma. 19,20 The type of ICH and the history of presentation influenced the panelists' decisions regarding the necessity of SS in children 6 to 23 months old. SS was rated necessary in all clinical scenarios involving SDHs but not in all scenarios involving EDHs, which have been associated with a lower risk of abuse.…”

Section: Discussionmentioning

confidence: 99%

Development of Guidelines for Skeletal Survey in Young Children With Intracranial Hemorrhage

Paine

Scribano²,

Localio

et al. 2016

BACKGROUND AND OBJECTIVE: As evidenced by the variation and disparities in evaluation, there is uncertainty in determining which young children with intracranial hemorrhage (ICH) should undergo evaluation with skeletal survey (SS) for additional injuries concerning for abuse. We aimed to develop guidelines for performing initial SS in children <24 months old presenting with ICH by combining available evidence from the literature with expert opinion.

“…109 Because brain injuries are often occult, head imaging should be considered for any child younger than 1 year with a fracture suspicious for abuse. 121 Imaging studies may help clarify whether the child has been abused, provide further support for a diagnosis of child abuse, and identify other injuries that require treatment. Additional imaging may be needed if the child has signs or symptoms of chest, abdominal, or neck injury.…”

mentioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Self Cite

247

162

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...