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03.14.03

Research helps identify signs of child abuse
 

n 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.