Duodenal injuries in children: beware of child abuse.
OBJECTIVE
It is frequently overlooked that child abuse may result in significant intraabdominal injury, particularly to the duodenum. The authors hypothesized that a significant number of duodenal injuries in young children would be the result of nonaccidental trauma.


METHODS
An 8-year (1995 through 2002) retrospective review of a pediatric level I trauma center database was performed after Institutional Review Board approval was obtained, and information regarding patients with duodenal injury was abstracted. Demographic variables, injury severity, length of stay, mortality rate, and mechanism of injury were examined. Statistical analysis was performed using descriptive statistics and Student's t test. Statistical significance was defined as P less than.05.


RESULTS
Over the 8-year study period, 8,968 patients were admitted, 2,179 (24%) were less than 3 years of age. Thirty children (0.3%) suffered injury to the duodenum, with 20 hematomas and 10 perforations. Patients were overwhelmingly boys (80%), with an average age of 7.6 +/- 4.4 years and Injury Severity Score (ISS) of 14 +/- 10. No patients died. Children were injured by a variety of mechanisms, including collisions involving motor vehicles (n = 9), bicycles (n = 4), and ATVs (n = 2). However, all children less than 4 years of age (n = 8) were victims of nonaccidental trauma, 2.8% of all child abuse admissions. Three of these children suffered perforations of the duodenum. Among the entire population, those children who suffered perforations had a significantly higher ISS (23.7 +/- 7.2 v 9.6 +/- 7.3; P <.0003) and longer length of stay (27.1 +/- 15.3 v 12.6 +/- 11.7; P <.007) than those with hematomas


CONCLUSIONS
Injury to the duodenum is unusual in the pediatric trauma patient but does result in significant injury severity and prolonged hospitalization. In the young child, one must maintain a high index of suspicion regarding the etiology of the injury, because a large percentage is potentially the result of child abuse.
Gaines
Barbara A
BA
Benedum Program in Trauma, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
Shultz
Barbara S
BS
Morrison
Katie
K
Ford
Henri R
HR
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000367:Age Factors; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002675:Child, Preschool; D004378:Duodenal Diseases / Q000453:epidemiology / Q000209:etiology*; D004386:Duodenum / Q000293:injuries*; D005260:Female; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D012622:Seat Belts / Q000009:adverse effects; D018805:Sepsis / Q000209:etiology; D012720:Severity of Illness Index; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000209:etiology