Suspicious childhood injury: Formulation of forensic opinion

Skellern, Catherine; Donald, Terence

doi:10.1111/j.1440-1754.2010.01773.x

Cited by 13 publications

(6 citation statements)

References 38 publications

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“…Although all deaths included in this study were unintentional, this raises a challenge for prevention. Neglect and child abuse have been previously identified in several studies as being associated with childhood injuries, including bathtub drowning . Parents and carers must also be made aware of the dangers of bathing children while under the influence of alcohol and illicit drugs.…”

Section: Discussionmentioning

confidence: 99%

Unintentional fatal child drowning in the bath: A 12‐year Australian review (2002–2014)

Peden

Franklin

Pearn

2017

J Paediatrics Child Health

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Section: Discussionmentioning

confidence: 99%

Unintentional fatal child drowning in the bath: A 12‐year Australian review (2002–2014)

Peden

Franklin

Pearn

2017

J Paediatrics Child Health

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“…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][3][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.…”

Section: Introductionmentioning

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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“…Child injury heals quicker than those of adults (Skellern-Donald, 2011). Thus, written documentation is essential even when photo documentation is provided of the case.…”

Section: Introductionmentioning

confidence: 99%

Accident or child abuse? Terminological requirements for clinical documentation of child injuries

Sirokmány,

Fogarasi,

Patonai

2023

Porta Lingua

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Since children are usually accompanied by an adult when they arrive at a healthcare facility, information about how the injury occurred also originates from the adult. To rule out the possibility of child abuse, the physician attending to child injuries should pay particular attention to whether the trauma marks on the child’s body correspond to the circumstances of the injury as described by the adult, e.g., whether the injury could have occurred spontaneously in the event of an accident, taking the child’s level of physical and mental maturity into consideration. As physical injuries to both the soft tissue and the skeleton heal more quickly in children than in adults, and the injury itself is the main evidence in any criminal proceedings, great care must be taken in documenting injuries. For this reason, forensic medicine has developed specialized literature on the requirements for documenting injuries in children. Such literature discusses in more detail the characteristics of each type of injury suffered by children. However, a challenging circumstance in clinical care is that the international diagnosis classification (ICD) currently used in Hungary does not treat child injuries separately, thus the pathologies, especially for bone fractures, cannot be coded in sufficient detail. In the present case study, we discuss the terminology used to describe child injuries in detail in comparison with the terminology used for adult injuries based on the literature. We then analyze the documentation of blunt force injuries in 45 clinical records of child injuries, with a special focus on the terms used to describe the external trauma marks and the pathology.

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Suspicious childhood injury: Formulation of forensic opinion

Cited by 13 publications

References 38 publications

Unintentional fatal child drowning in the bath: A 12‐year Australian review (2002–2014)

Unintentional fatal child drowning in the bath: A 12‐year Australian review (2002–2014)

Evaluating Children With Fractures for Child Physical Abuse

Accident or child abuse? Terminological requirements for clinical documentation of child injuries

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