Assessment of non-accidental injuries

The incidence of fractures in children under the age of 24 months–in relation to non-accidental injury. (2012)

Age is a strong determinant when accessing NAI and a non-ambulant child presenting with a femur or skull fracture should be regarded highly suspicious of NAI. The time interval between the injury and presentation to the ED must be recorded in all notes when assessing a child for NAI.

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Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. (2011)

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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Which injuries may indicate child abuse? (2010)

Making the decision as to whether an injury is a result of child abuse or not is stressful for both the family involved and the clinical team. It is not a decision that is taken lightly, and with an increasing expectation by the investigating agencies, lawyers and the public in general, to ensure that it is based on explicit ‘evidence’, clinicians need to be up to date with the latest scientific publications in the field. This article aims to summarise the current evidence in relation to all physical injuries except those pertaining to the central nervous system, which will form a separate article. It will examine the pattern of accidental and abusive bruises, fractures, burns, abdominal injuries and oral injuries focusing on discriminating features and necessary investigations.

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Incidence of fractures among children with burns with concern regarding abuse. (2010)

Consensus recommendations state that a radiographic skeletal survey is mandatory for all children <2 years of age with concern for physical abuse. It has been suggested that patients with burns may represent a special subgroup at lower risk for occult fractures, compared with other abused children. Our objective was to determine the prevalence of fractures in children referred for subspecialty abuse evaluations because of burns. The rate of fractures in children who present with burns and concerns regarding physical abuse is sufficient to support the recommendation for routinely performing skeletal surveys for children <2 years of age.

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Diagnostic imaging of child abuse. (2009)

The role of imaging in cases of child abuse is to identify the extent of physical injury when abuse is present and to elucidate all imaging findings that point to alternative diagnoses. Effective diagnostic imaging of child abuse rests on high-quality technology as well as a full appreciation of the clinical and pathologic alterations occurring in abused children. This statement is a revision of the previous policy published in 2000.

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Evaluation of suspected child physical abuse. (2007)

This report provides guidance in the clinical approach to the evaluation of suspected physical abuse in children. The medical assessment is outlined with respect to obtaining a history, physical examination, and appropriate ancillary testing. The role of the physician may encompass reporting suspected abuse; assessing the consistency of the explanation, the child’s developmental capabilities, and the characteristics of the injury or injuries; and coordination with other professionals to provide immediate and long-term treatment and follow-up for victims. Accurate and timely diagnosis of children who are suspected victims of abuse can ensure appropriate evaluation, investigation, and outcomes for these children and their families.

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Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review. (2005)

When abuse is suspected, bruising must be assessed in the context of medical, social, and developmental history, the explanation given, and the patterns of non-abusive bruising. Bruises in non-mobile infants, over soft tissue areas, that carry the imprint of an implement and multiple bruises of uniform shape are suggestive of abuse. Quality research across the whole spectrum of children is urgently needed.

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More articles on non-accidental trauma from PubMed.

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