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a study published in the March issue of the journal Pediatrics,
Children’s researchers report that infants who come into the
Emergency Department with a serious head injury and no mention of
trauma to explain the injury are highly likely to be victims of
child abuse.
“In every single case where there was no history
of trauma and the child ended up with neurological damage, it was
later determined that the injury was caused by abuse,” says
Joeli
Hettler, MD, assistant in Emergency Medicine and one
of the lead authors of the study.
The study was based on a retrospective review of 200
patient charts of children from birth to age 3 who were admitted
to Children’s with serious bleeding in the head from 1993–2000.
Researchers looked at medical information such as a patient’s
neurological status, results of radiological studies, and ophthalmologic
exam findings to classify patients as either “Definite Abuse”
or “Not Definite Abuse.” They then went back and looked
at initial presenting histories to assess whether those histories
were a reliable predictor of Definite Abuse.
They also found that among the subgroup of patients
with persistent neurologic abnormality at hospital discharge, those
who did not have a history of high-impact (defined as a fall greater
than three feet) trauma or those that reported a history of low-impact
(defined as a fall from less than three feet) were also likely victims
of abuse. This was consistent with a prior Children’s study
that showed that low-impact trauma is unlikely to result in neurological
impairment.
The third relevant finding was that when caregivers
or parents attributed injuries to their own vigorous attempts to
resuscitate a child, abuse was always the cause of injuries, and
that in cases where parents changed their stories over the course
of treatment at the hospital, abuse was again determined to be the
cause of injury in all cases.
“These findings underscore how important it is
for caregivers to take accurate histories so the likelihood of abuse
can most accurately be assessed,” says Andrea
Vandeven, MD, MPH, assistant in Medicine and director of
Children’s Child Protection Team. “These guideposts can
be useful for caregivers who are all too often put in the situation
of assessing whether abuse has occurred.”
David
Greenes, MD, assistant in Emergency Medicine, was the study’s
other lead author.
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