Utility of Hepatic Transaminases to Recognize Abuse in Children

Lindberg, Daniel M.; Makoroff, Kathi L.; Harper, Nancy S.; Laskey, Antoinette L.; Bechtel, Kirsten; Deye, Katherine; Shapiro, Robert A.

doi:10.1542/peds.2008-2348

Cited by 87 publications

(51 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most important, because their investigation was ancillary to a larger multicenter study, 13 the authors were unable to determine the effect of their recommendations on clinical practice. As part of the parent study, data were available on 1676 children who underwent evaluation for suspected physical abuse.…”

Section: A B U S I V E H E a D T R A U M A (Aht) Is The Leading Causementioning

confidence: 99%

Retinal Hemorrhages in Low-Risk Children Evaluated for Physical Abuse

Mitchell²,

Fromkin³

et al. 2011

Arch Pediatr Adolesc Med

View full text Add to dashboard Cite

Section: A B U S I V E H E a D T R A U M A (Aht) Is The Leading Causementioning

confidence: 99%

Retinal Hemorrhages in Low-Risk Children Evaluated for Physical Abuse

Mitchell²,

Fromkin³

et al. 2011

Arch Pediatr Adolesc Med

View full text Add to dashboard Cite

“…[6][7][8] Several diagnostic studies (eg, skeletal survey [SS], neuroimaging, hepatic transaminases, and retinal examination) can identify occult abusive injuries and improve abuse recognition and diagnosis. [9][10][11][12][13][14][15] However, use of these studies has been shown to be widely variable, and to be affected by practice setting, race, and socioeconomic status. 16,17 Twice as many children with highrisk injuries are recognized as abused in children's hospitals than in general hospitals, 18 and abusive fractures are 7 times more likely to be missed in general emergency departments (EDs) than in pediatric EDs.…”

mentioning

confidence: 99%

Testing for Abuse in Children With Sentinel Injuries

Lindberg¹,

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

“…Online discussion comments provided insight into the decisionmaking reflected in the process of consensus development. 20 Some were surprised by practices recommended by other participants, including, "Neck imaging in children with head injury … is this something that everyone is already doing?" 21 Participants also considered the role of CAP evaluations in future research: "In regard to race/ethnicity, how great would it be for research if all CAP reports had this available.…”

Section: Consensus Guideline Developmentmentioning

confidence: 99%