Frena Tears and Abusive Head Injury

Thackeray, Jonathan D.

doi:10.1097/pec.0b013e3181568039

Cited by 67 publications

(49 citation statements)

References 3 publications

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“…54,55 The majority of sentinel injuries are bruises, intraoral injuries, including frena tears, or fractures. [57][58][59][60] Physicians sometimes underappreciate the significance of sentinel injuries or attribute them to noninflicted trauma, self-inflicted trauma, or medical disease. 54 Physicians may overlook injuries that are commonly considered accidental in ambulatory children but have higher specificity for abuse in young infants.…”

Section: Missed Opportunities For Diagnosing Physical Abusementioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

461

301

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Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.

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Section: Missed Opportunities For Diagnosing Physical Abusementioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

461

301

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“…Over the past 25 years, research has repeatedly highlighted missed opportunities to evaluate and diagnose abuse in young, injured children, resulting in children suffering from undiagnosed injuries as well as ongoing abuse. [36][37][38][39][40][41][42][43] Research has also revealed that racial and socioeconomic status (SES)-based biases influence decision-making regarding child abuse evaluations and diagnoses. 17,31,35,44,45 A single institution study of unwitnessed TBI in infants showed that implementation of a guideline for universal occult fracture evaluation in this population can eliminate racial and SES-based disparities and might increase the detection of abuse.…”

Section: Discussionmentioning

confidence: 99%

Evaluation for Occult Fractures in Injured Children

et al. 2015

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OBJECTIVES: To examine variation across US hospitals in evaluation for occult fractures in (1) children ,2 years old diagnosed with physical abuse and (2) infants ,1 year old with injuries associated with a high likelihood of abuse and to identify factors associated with such variation. METHODS:We performed a retrospective study in children ,2 years old with a diagnosis of physical abuse and in infants ,1 year old with non-motor vehicle crash-related traumatic brain injury or femur fractures discharged from 366 hospitals in the Premier database from 2009 to 2013. We examined across-hospital variation and identified child-and hospital-level factors associated with evaluation for occult fractures.RESULTS: Evaluations for occult fractures were performed in 48% of the 2502 children with an abuse diagnosis, in 51% of the 1574 infants with traumatic brain injury, and in 53% of the 859 infants with femur fractures. Hospitals varied substantially with regard to their rates of evaluation for occult fractures in all 3 groups. Occult fracture evaluations were more likely to be performed at teaching hospitals than at nonteaching hospitals (all P , .001). The hospital-level annual volume of young, injured children was associated with the probability of occult fracture evaluation, such that hospitals treating more young, injured patients were more likely to evaluate for occult fractures (all P , .001).CONCLUSIONS: Substantial variation in evaluation for occult fractures among young children with a diagnosis of abuse or injuries associated with a high likelihood of abuse highlights opportunities for quality improvement in this vulnerable population.WHAT'S KNOWN ON THIS SUBJECT: Screening for occult fractures is a key component of the medical evaluation for young victims of suspected physical abuse. Little is known about adherence to occult fracture evaluation guidelines in children with suspected abuse cared for at non-pediatric-focused hospitals.WHAT THIS STUDY ADDS: Occult fracture evaluations were performed in half of young children diagnosed with abuse or injuries concerning for abuse in a large cohort of hospitals. Evaluations were more common at hospitals caring for higher volumes of young, injured children.

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“…Several such sentinel injuries have been suggested on the basis of case reports and retrospective analyses of cohorts of abused children. [22][23][24] However, these studies have not been able to estimate the likelihood of abuse in children with these injuries because they have not identified the denominator of children presenting with these injuries. One large analysis of the association between fractures and abuse was able to overcome this challenge, but was limited to children who were admitted to the hospital.…”

mentioning

confidence: 99%

Testing for Abuse in Children With Sentinel Injuries

Lindberg¹,

et al. 2015

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OBJECTIVE: Child physical abuse is commonly missed, putting abused children at risk for repeated injury and death. Several so-called sentinel injuries have been suggested to be associated with high rates of abuse, and to imply the need for routine testing for other, occult traumatic injuries. Our objective was to determine rates of abuse evaluation and diagnosis among children evaluated at leading children's hospitals with these putative sentinel injuries.METHODS: This is a retrospective secondary analysis of the Pediatric Health Information System database. We identified 30 355 children with putative sentinel injuries. We measured rates of abuse diagnosis and rates of testing commonly used to identify occult injuries.RESULTS: Among all visits for children ,24 months old to Pediatric Health Information System hospitals, the rate of abuse diagnosis was 0.17%. Rates of abuse diagnosis for children with at least 1 putative sentinel injury ranged from 3.5% for children ,12 months old with burns to 56.1% for children ,24 months with rib fractures. Rates of skeletal survey and other testing that can identify occult traumatic injury were highly variable between centers and for different injuries.CONCLUSIONS: Several putative sentinel injuries are associated with high rates of physical abuse. Among eligible children with rib fracture(s), abdominal trauma, or intracranial hemorrhage, rates of abuse were more than 20%. Future work is warranted to test whether routine testing for abuse in these children can improve early recognition of abuse.

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Frena Tears and Abusive Head Injury

Cited by 67 publications

References 3 publications

The Evaluation of Suspected Child Physical Abuse

The Evaluation of Suspected Child Physical Abuse

Evaluation for Occult Fractures in Injured Children

Testing for Abuse in Children With Sentinel Injuries

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