Spine Injuries in Child Abuse

Jauregui, Julio J.; Perfetti, Dean C.; Cautela, Frank S.; Frumberg, David B.; Naziri, Qais; Paulino, Carl B.

doi:10.1097/bpo.0000000000000877

Cited by 14 publications

(18 citation statements)

References 22 publications

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“… MRI Spinal injury is seen in most AHT children and might be clinically and forensically valuable. Jauregui et al, 2019 [ 42 ] 116 abused and 22,076 non abused (ma 2.1 and 13.9, respectively) All levels No increased risk of spinal cord injury in abused compared with non-abused (OR = 1.51). Abused have increased risk of vertebral fractures at thoraco (OR = 2.97) and lumbar (OR = 1.67) level.…”

Section: Introductionmentioning

confidence: 99%

“…Probably the most comprehensive study was the one from Jauregui et al (2019) who retrospectively reviewed 22,192 children with spinal column fractures or spinal cord injuries [ 42 ]. Patients were identified from Kids’ Inpatients Database (KID) using ICD-9-CM diagnosis (cervical, thoracic, lumbar vertebral fracture and spinal cord injury).…”

Section: Introductionmentioning

confidence: 99%

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Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

et al. 2021

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Abusive head trauma (AHT) in children is notoriously one of the most challenging diagnoses for the forensic pathologist. The pathological “triad”, a combination of intracranial subdural haematoma, cerebral oedema with hypoxic-ischaemic changes and retinal haemorrhages, is frequently argued to be insufficient to support a corroborated verdict of abuse. Data from all available English-language scientific literature involving radiological and neuropathological spinal cord examination is reviewed here in order to assess the contribution of spinal cord changes in differentiating abusive from accidental head trauma. In agreement with the statistically proven association between spinal subdural haemorrhage (SDH) and abuse (Choudhary et al. in Radiology 262:216–223, 2012), spinal blood collection proved to be the most indicative finding related to abusive aetiology. The incidence of spinal blood collection is as much as 44–48% when all the spinal cord levels are analysed as opposed to just 0–18% when the assessment is performed at cervical level only, in agreement with the evidence of the most frequent spinal SDH location at thoracolumbar rather than cervical level. In this review, the source of spinal cord blood collection and how the age of the child relates to the position of spinal cord lesions is also discussed. We concluded that the ante mortem MRI examination and post mortem examination of whole-length spinal cord is of fundamental interest for the assessment of abuse in the forensic setting.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

et al. 2021

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“…These fractures are felt to be highly specific for child abuse if the injury is unexplained or inconsistent with the history, or if the injury is not consistent with the child's developmental age and abilities (3,18,20,38,40,49). It is also considered highly specific for child abuse when the child is under two years of age (50).…”

Section: Biomechanics Of the Lumbar Spinementioning

confidence: 99%

Abusive Pediatric Thoracolumbar Fracture Due to Forced Hyperextension: Case Report, Biomechanical Considerations, and Review of the Literature

Webb¹,

Sherman

Sung³

et al. 2020

Journal of Forensic Sciences

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Pediatric thoracolumbar fractures are rare due to the physiological differences which afford greater resilience to the immature spine. Most pediatric thoracolumbar fractures occur as the result of high energy trauma, such as motor vehicle accidents, and modes of reasonable accidental injuries are limited by age and developmental capabilities of the child. These fractures can occur as the result of inflicted blunt force trauma and child abuse, and in most cases, the mechanism of injury to the spine is not known. We report the death of a 29-month-old man due to blunt force trauma to the back and forced hyperextension of the thoracolumbar spine causing fracture of the fourth lumbar (L4) vertebral body. A complete forensic examination revealed a previous healing fracture of the anterior aspect of the L4 vertebral body, with acute disruption of the anterior longitudinal ligament overlying the fracture site, complete fracture of the vertebral body, and fatal retroperitoneal hemorrhage. We present a review of the biomechanical considerations of the pediatric spine, a survey of pediatric spinal fractures, and a review of the literature on pediatric abusive thoracolumbar fractures. In this case, there was never a provided explanation for how the injury occurred; however, understanding the biomechanics of the pediatric spine allowed for the determination of the mechanism, force required to produce this specific pattern of abusive spinal injury, and the manner of death.

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“…This creates a fairly representative sample of annual U.S. pediatric hospital admissions. 16 Each patient's discharge record contains demographic and clinical data, including ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis and procedure codes. The KID database is publicly available to researchers and contains deidentified data, and was deemed exempt from our institutional review board.…”

Section: Databasementioning

confidence: 99%

Septic arthritis of the hip and knee treated surgically in pediatric patients: Analysis of the Kids’ Inpatient Database

Tretiakov

Cautela

Walker

et al. 2019

Journal of Orthopaedics

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This study evaluated incidence over time, any association between race and demographics, and hospital-related parameters in pediatric patients with septic hip or knee arthritis. Methods: The Kids' Inpatient Database was used to identify all children with a diagnosis of septic hip or knee arthritis who underwent incision and drainage (1997-2012). Results: Between 1997 and 2012, overall incidence of septic arthritis of the knee (0.20-0.33 per 100,000) and hip (0.12-0.18 per 100,000) increased. Conclusion: Incidence of pediatric septic joint arthritis, an emergent orthopaedic condition, has increased over time. Patient demographics may vary with respect to both age and race.

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Spine Injuries in Child Abuse

Abstract: Level III evidence-a case-control study.

Cited by 14 publications

References 22 publications

Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

Abusive Pediatric Thoracolumbar Fracture Due to Forced Hyperextension: Case Report, Biomechanical Considerations, and Review of the Literature

Septic arthritis of the hip and knee treated surgically in pediatric patients: Analysis of the Kids’ Inpatient Database

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