Screening for occult abdominal trauma in children with suspected physical abuse.
OBJECTIVE
The goals were (1) to determine the prevalence of occult abdominal trauma (OAT) in a sample of children with suspected physical abuse, (2) to assess the frequency of OAT screening, and (3) to assess factors associated with screening.


METHODS
Charts of children evaluated for abusive injury were identified through a search of hospital discharge codes. Identified charts were reviewed to determine whether OAT screening occurred. Data on results of screening tests, abusive injuries identified, family demographic features, and characteristics of the emergency department visit were collected.


RESULTS
Screening occurred for 51 (20%) of 244 eligible children. Positive results were identified for 41% of those screened and 9% of the total sample; 5% of children 12 to 23 months of age had OAT identified through imaging studies. Screening occurred more often in children presenting with probable abusive head trauma (odds ratio [OR]: 20.4 [95% confidence interval [CI]: 3.6-114.6]; P < .01), compared with those presenting with other injuries. Consultation with the child protection team (OR: 8.5 [95% CI: 3.5-20.7]; P < .01) and other subspecialists (OR: 24.3 [95% CI: 7.1-83.3]; P < .01) also increased the likelihood that OAT screening would occur.


CONCLUSIONS
Our findings support OAT screening with liver and pancreatic enzyme measurements for physically abused children. This study also supports the importance of subspecialty input, especially that of a child protection team. Although many identified injuries may not require treatment, their role in confirming or demonstrating increased severity of maltreatment may be critical.
Lane
Wendy Gwirtzman
WG
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. wlane@epi.umaryland.edu
Dubowitz
Howard
H
Langenberg
Patricia
P
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D000410:Alanine Transaminase / Q000097:blood; D000681:Amylases / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data*; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D016489:Head Injuries, Closed / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008049:Lipase / Q000097:blood; D008099:Liver / Q000293:injuries; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D010179:Pancreas / Q000293:injuries; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology*
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D008049:Lipase; D000681:Amylases