The Mistaken Diagnosis of Child Abuse

Kirschner, R; Stein, Robert J.

doi:10.1001/archpedi.1985.02140110027022

Cited by 60 publications

(15 citation statements)

References 14 publications

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“…Clinically, retinal hemorrhages can be divided into intravitreal, preretinal, intraretinal, subretinal, and subretinal pigment epithelial or choroidal (Figs. [1][2][3][4][5]. Each of these hemorrhages has a characteristic, recognizable appearance, and each carries its own distinct diagnostic and prognostic implications.…”

Section: Types Of Retinal Hemorrhagementioning

confidence: 99%

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Retinal hemorrhage and pediatric brain injury: etiology and review of the literature

Aryan

Ghosheh

Jandial

et al. 2005

Journal of Clinical Neuroscience

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Section: Types Of Retinal Hemorrhagementioning

confidence: 99%

“…The presence of retinal hemorrhages is therefore not sufficient for the diagnosis of child abuse. [1][2][3][4] …”

Section: Introductionmentioning

confidence: 99%

Retinal hemorrhage and pediatric brain injury: etiology and review of the literature

Aryan

Ghosheh

Jandial

et al. 2005

Journal of Clinical Neuroscience

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“…13,14,[22][23][24][25] Although one of these reports is a prospective evaluation of children who received CPR, most reports are anecdotes in which the arrests were not witnessed by anyone but the care giver. In fact, in the prospective study, one of the two arrests occurred out-of-hospital although the cause of the in-hospital arrest was unwitnessed and the diagnosis of sudden infant death was made.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Retinal Hemorrhages in Pediatric Patients After In-hospital Cardiopulmonary Resuscitation: A Prospective Study

Odom¹,

Christ²,

Kerr

et al. 1997

Pediatrics

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ABSTRACT. Objective. Child abuse occurs in 1% of children in the United States every year; 10% of the traumatic injuries suffered by children under 5 years old are nonaccidental, and 5% to 20% of these nonaccidental injuries are lethal. Rapid characterization of the injury as nonaccidental is of considerable benefit to child protection workers and police investigators seeking to safeguard the child care environment and apprehend and prosecute those who have committed the crime of child abuse. Physically abused children present with a variety of well-described injuries that are usually easily identifiable. In some cases, however, particularly those involving children with the shaken baby syndrome, obvious signs of physical injury may not exist. Although external signs of such an injury are infrequent, the rapid acceleration-deceleration forces involved often cause subdural hematomas and retinal hemorrhages, hallmarks of the syndrome. Frequently, retinal hemorrhages may be the only presenting sign that child abuse has occurred. Complicating the interpretation of the finding of retinal hemorrhages is the belief by some physicians that retinal hemorrhages may be the result of chest compressions given during resuscitative efforts. The objective of this study is to determine the prevalence of retinal hemorrhages after inpatient cardiopulmonary resuscitation (CPR) in pediatric patients hospitalized for nontraumatic illnesses in an intensive care unit.Design. Prospective clinical study. Setting. Pediatric intensive care unit. Patients. Forty-three pediatric patients receiving at least 1 minute of chest compressions as inpatients and surviving long enough for a retinal examination. Patients were excluded if they were admitted with evidence of trauma, documented retinal hemorrhages before the arrest, suspicion of child abuse, or diagnosis of neardrowning or seizures. All of the precipitating events leading to cardiopulmonary arrest occurred in our intensive care unit, eliminating the possibility of physical abuse as an etiology.Interventions. None. Measurements. Examination of the retina was performed by one of two pediatric ophthalmologists within 96 hours of CPR. The chart was reviewed for pertinent demographic information; the platelet count, prothrombin time, and partial thromboplastin time proximate to the CPR were recorded if they had been determined.Results. A total of 43 pediatric patients hospitalized with nontraumatic illnesses survived 45 episodes of inpatient CPR. The mean age was 23 months (range, 1 month to 15.8 years), and 84% of the patients were under 2 years old. The majority of the patients (44%) were admitted to the intensive care unit after surgery for congenital heart disease, and another 21% were admitted for respiratory failure. The mean duration of chest compressions was 16.4 minutes ؎ 17 minutes with 58% lasting between 1 and 10 minutes. Five patients had chest compressions lasting >40 minutes, and two patients had open chest cardiac massage. All patients survived their resuscitative efforts. Nin...

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“…32,37 Paramedics and emergency department personnel should be trained to distinguish normal findings, such as postmortem anal dilation and lividity, from trauma attributable to abuse. 46,47 When a previously healthy infant has died unexpectedly in the absence of external evidence of injury or initial history/scene findings suggestive of another cause/manner of death, then a preliminary diagnosis of "possible SIDS" may be given. Assignment of this preliminary diagnosis should not limit or prevent subsequent thorough case investigation.…”

Section: Management Of Sudden Unexpected Infant Deathmentioning

confidence: 99%

Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities

Hymel¹

2006

Pediatrics

113

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Fatal child abuse has been mistaken for sudden infant death syndrome. When a healthy infant younger than 1 year dies suddenly and unexpectedly, the cause of death may be certified as sudden infant death syndrome. Sudden infant death syndrome is more common than infanticide. Parents of sudden infant death syndrome victims typically are anxious to provide unlimited information to professionals involved in death investigation or research. They also want and deserve to be approached in a nonaccusatory manner. This clinical report provides professionals with information and suggestions for procedures to help avoid stigmatizing families of sudden infant death syndrome victims while allowing accumulation of appropriate evidence in potential cases of infanticide. This clinical report addresses deficiencies and updates recommendations in the 2001 American Academy of Pediatrics policy statement of the same name.

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The Mistaken Diagnosis of Child Abuse

Cited by 60 publications

References 14 publications

Retinal hemorrhage and pediatric brain injury: etiology and review of the literature

Retinal hemorrhage and pediatric brain injury: etiology and review of the literature

Prevalence of Retinal Hemorrhages in Pediatric Patients After In-hospital Cardiopulmonary Resuscitation: A Prospective Study

Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities

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