Additional injuries in young infants with concern for abuse and apparently isolated bruises.
OBJECTIVE
To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising.


METHODS
This was a prospectively planned secondary analysis of an observational study of children<10 years (120 months) of age evaluated for possible physical abuse by 20 US child abuse teams. This analysis included infants<6 months of age with apparently isolated bruising who underwent diagnostic testing for additional injuries or bleeding disorders.


RESULTS
Among 2890 children, 33.9% (980/2890) were <6 months old, and 25.9% (254/980) of these had bruises identified. Within this group, 57.5% (146/254) had apparently isolated bruises at presentation. Skeletal surveys identified new injury in 23.3% (34/146), neuroimaging identified new injury in 27.4% (40/146), and abdominal injury was identified in 2.7% (4/146). Overall, 50% (73/146) had at least one additional serious injury. Although testing for bleeding disorders was performed in 70.5% (103/146), no bleeding disorders were identified. Ultimately, 50% (73/146) had a high perceived likelihood of abuse.


CONCLUSIONS
Infants younger than 6 months of age with bruising prompting subspecialty consultation for abuse have a high risk of additional serious injuries. Routine medical evaluation for young infants with bruises and concern for physical abuse should include physical examination, skeletal survey, neuroimaging, and abdominal injury screening.
Children's Physician Services of South Texas, Driscoll Children's Hospital, Corpus Christi, TX. Electronic address: nancy.harper@dchstx.org.
Nancy S
NS
Harper
Children's Protection Program, Odessa Brown Children's Clinic, Seattle Children's Hospital, University of Washington.
Kenneth W
KW
Feldman
Seattle Children's Hospital, University of Washington, Seattle, WA.
Naomi F
NF
Sugar
Division of Child Abuse and Neglect, Children's Mercy Hospital, UMKC School of Medicine, Kansas City, MO.
James D
JD
Anderst
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Kempe Center for the Prevention and Treatment of Child Abuse, Department of Pediatrics, Children's Hospital of Colorado, Aurora, CO.
Daniel M
DM
Lindberg
D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D003288:Contusions / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010808:Physical Examination; D015995:Prevalence; D011446:Prospective Studies; D017695:Soft Tissue Injuries / Q000175:diagnosis*; D014481:United States