Repeat Visitors to a Pediatric Forensic Medicine Program

Handy, Tracey Corey; Nichols, George R.; Smock, William

doi:10.1520/jfs14007j

Cited by 6 publications

(5 citation statements)

References 4 publications

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“…Repeat physical abuse of children after they returned home from protective custody or hospital alert us to the need for more vigorous prevention of child abuse. Handy et al 6 . reported on six children who suffered repeat physical abuse after returning to their original homes.…”

Section: Discussionmentioning

confidence: 99%

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Patterned injuries in children who have suffered repeated physical abuse

Kibayashi

Shojo

2003

Pediatrics International

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Section: Discussionmentioning

confidence: 99%

“…Handy et al . 6 reported on six children who suffered repeat physical abuse after returning to their original homes. Two of them died from the injuries they sustained in a second abusive assault, which suggests that even a definitive diagnosis of intentional injury does not ensure the future safety of the child.…”

Section: Discussionmentioning

confidence: 99%

Patterned injuries in children who have suffered repeated physical abuse

Kibayashi

Shojo

2003

Pediatrics International

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“…[ 16 , 46 ] Similar to that reported in literature, our data also reflect a slight male predominance. [ 21 , 24 , 29 , 43 , 45 , 48 ] As noted above, providers need to have a high level of suspicion to recognize and diagnose these injuries, and it is critical for providers to perform meticulous examination to identify bruising, external trauma, or other injuries in patients suspected of AHT. Oftentimes, patients may present with nonspecific symptoms, such as vomiting, altered mental status, or seizures, which do not immediately suggest AHT, or the patient history may change, be incorrect, and even absent of any report of trauma.…”

Section: Discussionmentioning

confidence: 99%

Pediatric abusive head trauma: ThinkFirst national injury prevention foundation

Wilson¹,

Gospodarev²,

Hendrix³

et al. 2021

Surgical Neurology International

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Background: Pediatric abusive head trauma (AHT) represents 80% of nonaccidental trauma deaths, remaining a lead cause of death among infants and young children. Furthermore, neurosurgical intervention can ameliorate damage from secondary injury, but we are currently unable to alter the impact of the primary injury. Thus, prevention through increased public awareness is imperative. This study identifies injuries and predictors of outcomes in pediatric AHT and highlights the importance of partnering with our community through ThinkFirst, a national injury prevention foundation, to educate parents and caregivers about prevention. Methods: This single-institution retrospective review identifies injuries and predictors of outcomes in pediatric AHT and highlights the importance of partnering with our community to raise awareness and educate parents and caregivers about prevention. Results: The number of pediatric AHT cases continues to steadily increase over time (P < 0.001), and over 70% of these patients are <1 year of age (P < 0.001). Patients suffering AHT have a mortality rate of nearly 10%. In addition to morbidity and mortality, the economic burden of caring for abused children is high as they often require high levels of care, long hospital stays, and extensive rehabilitation. Furthermore, Medicaid pays for nearly 80% of these patients. Conclusion: The population of patients with AHT is unique, and one that will benefit from continued efforts at increased multidisciplinary and public awareness. Prevention of AHT through awareness is critical. Through partnering with ThinkFirst, a national injury prevention foundation, we aim to educate parents and caregivers about prevention.

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“…As many as 50% of children who present with abuse have a history of prior injury, and studies demonstrate increased morbidity and mortality in children experiencing recurrent abuse. [2][3][4][5][6][7] The term sentinel injury (SI) has emerged to describe often relatively minor abusive injuries that may precede more severe recurrent abuse. Sheets et al 8 retrospectively reviewed parent provided histories of 401 infants primarily younger than 7 months for the presence of SI, defined as "a previous injury reported in the medical history that was suspicious for abuse because the infant could not cruise, or the explanation was implausible."…”

mentioning

confidence: 99%

“…Early recognition of physical abuse is critical because children often experience physical abuse as recurrent events within their environment. As many as 50% of children who present with abuse have a history of prior injury, and studies demonstrate increased morbidity and mortality in children experiencing recurrent abuse 2–7 …”

mentioning

confidence: 99%

Identification of Initial and Subsequent Injury in Young Infants

et al. 2022

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The objective of this study was to identify opportunities to improve identification and evaluation of child abuse by (1) describing rates of initial and recurrent injury in young infants, (2) describing the frequency of a history of prior injury in young children evaluated by a child abuse pediatrician, and (3) identifying practice variation, including use of skeletal surveys as an example, in the identification and evaluation of injury across a network of 6 children's hospitals.Methods: Six children's hospitals identified infants with an initial injury and recurrent injury over a 1-year period using 2 methods: (1) diagnostic code methodinfants 6 months or younger presenting with at least 1 diagnostic code for injury were tracked for 12 months to determine the frequency of recurrent injury, and (2) consult methodall available medical records of children 18 months or younger seen for an inpatient consultation for suspected child abuse were reviewed to identify history of a first injury at 6 months or younger.Results: Using the diagnostic code method, 682 unique infants were identified with initial injuries, most commonly fractures (37.0%), bruising/ ecchymosis (35.9%), and superficial injuries (28.3%). Forty-two infants (6.2%) returned with a second injury, and no demographic factors were significantly associated with the likelihood of a second injury. Using the consult method, 37 of 342 consults (10.8%) were identified as having a history of at least 1 initial injury. Of the initial injuries identified, the most common was bruising/ecchymosis (64.9%). The number of injuries identified with either method varied significantly across hospitals, as did completion of skeletal surveys for infants with bruising (range, 4.5%-71.1%; P < 0.001) and any injury (range, 4.4%-62.7%; P < 0.001). Conclusions:Our study demonstrates that young infants who experience 1 injury often experience a second injury. There exists significant variability in the identification of injury and the completion of skeletal surveys across a network of 6 children's hospitals. A standardized quality improvement approach may improve identification of injury and reduce the variability in practice observed.

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Repeat Visitors to a Pediatric Forensic Medicine Program

Cited by 6 publications

References 4 publications

Patterned injuries in children who have suffered repeated physical abuse

Patterned injuries in children who have suffered repeated physical abuse

Pediatric abusive head trauma: ThinkFirst national injury prevention foundation

Identification of Initial and Subsequent Injury in Young Infants

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