Diagnostic testing for and detection of physical abuse in infants with brief resolved unexplained events

Doswell, Angela; Anderst, James D.; Tieder, Joel S.; Herman, Bruce; Hall, Matt; Wilkins, Victoria; Knochel, Miguel L.; Kaplan, Ron L.; Cohen, Arthur A.; DeLaroche, Amy M.; Harper, Beth D.; Mittal, Manoj K.; Shastri, Nirav; Prusakowski, Melanie K.; Puls, Henry T.

doi:10.1016/j.chiabu.2022.105952

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…15 This hypothesis is consistent with previous studies evaluating the percentage of children presenting with nonspecific chief complaints who were ultimately given a diagnosis of abuse. For example, Doswell et al 16 found that 0.3% of infants presenting with a brief resolved unexplained event were ultimately given a diagnosis of abuse. Thus, our study does not support recommending a full evaluation for abuse including occult injury testing in all young children presenting with one of these nonspecific symptoms.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Triage Chief Complaints Among Children Evaluated for Physical Abuse Concerns

Fortin,

Wood,

Udell

et al. 2024

Pediatr Emer Care

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Objectives The aims of this study were to describe chief complaints provided at emergency department triage for young children ultimately given a diagnosed with injuries concerning for physical abuse and compare chief complaints by hospital child protection team assessment (abuse most likely, accident most likely, undetermined) among children younger than 2 years who were the subject of a report to child protective services. Methods This is a retrospective review of children evaluated by the child protection team at an urban children's hospital over a 5-year period. Children younger than 2 years who were the subject of a report to child protective services for suspected physical abuse were included. Chief complaints noted in emergency department triage notes were categorized as follows: 1, medical sign or symptom; 2, accidental trauma incident; 3, identified injury; 4, concern for abuse; or 5, multiple unrelated complaints. Child protection team assessments were categorized as follows: 1, abuse most likely; 2, accident most likely; or 3, undetermined. We used descriptive statistics and tests of association (χ2, Fisher exact, Kruskal-Wallis). Results Median age of the 422 children included was 4.9 months. Child protection team assessment was abuse most likely in 44%, accident most likely in 23%, and undetermined in 34%. Chief complaints in the overall sample were 39% medical, 29% trauma incident, 16% injury, 10% abuse concern, and 6% multiple unrelated. When the abuse most likely and accident most likely groups were compared, medical chief complaints were more common in the former (47% vs 19%, P < 0.001), whereas trauma incident chief complaints were more common in the latter (19% vs 64%, P < 0.001). Most common medical complaints in the abuse most likely group were altered mental status, abnormal limb use, swelling, pain, apnea, and vomiting. Conclusion Many children found to have injuries concerning for abuse (47%) present without mention of trauma, injury, or abuse concern as part of the chief complaint. Our findings suggest important topics to include in training physicians about recognition of abuse.

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Section: Discussionmentioning

confidence: 99%

Emergency Department Triage Chief Complaints Among Children Evaluated for Physical Abuse Concerns

Fortin,

Wood,

Udell

et al. 2024

Pediatr Emer Care

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Acute presentation of abusive head trauma

Hartman,

Greene

2024

Seminars in Pediatric Neurology

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Brief Resolved Unexplained Event: Evidence-Based and Family-Centered Management

Nama,

DeLaroche,

Bonkowsky

et al. 2024

Pediatrics in Review

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Brief resolved unexplained events (BRUEs) are frequently encountered in infants younger than 1 year. By definition, these events require the infant to be asymptomatic and at baseline at the time of presentation, with no significant abnormalities on examination and no discernible explanatory diagnosis. Research has shown that less than 5% of BRUE cases are attributable to serious underlying conditions, with no increased mortality risk and no increased risk of sudden infant death syndrome. Despite these findings, approximately 63% of patients with BRUEs are hospitalized and up to 82% undergo diagnostic tests, which predominantly result in false-positive findings. Such results may lead to unnecessarily prolonged hospital stays, additional tests or consultations, and increased parental anxiety. The management of a patient who has experienced a BRUE can be challenging for providers and parents alike. Although risk is known to be low in these infants, providers may be compelled to explain the event and provide reassurance. Caregivers oftentimes are concerned that the events may reoccur and be a harbinger of a missed diagnosis. Shared decision-making can be used to explain risk and the benefit of additional testing and hospitalization. This family-centered strategy can align care with the family’s values, provide reassurance, and decrease decisional conflict.

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Diagnostic testing for and detection of physical abuse in infants with brief resolved unexplained events

Cited by 3 publications

References 19 publications

Emergency Department Triage Chief Complaints Among Children Evaluated for Physical Abuse Concerns

Emergency Department Triage Chief Complaints Among Children Evaluated for Physical Abuse Concerns

Acute presentation of abusive head trauma

Brief Resolved Unexplained Event: Evidence-Based and Family-Centered Management

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