title: Inadequate sociomedical evaluation of possible abusive head trauma in Yokohama.
abstract: BACKGROUND
  There have been no previous studies on the adequacy of combined evaluation of possible abusive head trauma cases by frontline medical personnel, hospital-based child protection teams, and child protective services in local districts of Japan.
  
  
  METHODS
  We conducted a questionnaire survey of hospitalized patients under 24 months old with a diagnosis of intracranial hemorrhage (ICH) from January 2011 to December 2013. Eleven large-scale general hospitals in Yokohama, Japan were surveyed, which provide centralized inpatient care to moderately-severely ill children.
  
  
  RESULTS
  A total of 51 ICH patients were listed from eight hospitals. Median patient age was 7 months, and 84% were younger than 12 months. The most common diagnosis on computed tomography was subdural hematoma (n = 26; 51%). Of a total of 51 cases, 31 (61%) occurred inside the home; the injury scene was unknown in six cases (12%). We reviewed these 37 cases from the viewpoint of evaluation with concern for suspected child abuse. Three out of 37 patients (8%) were not examined for inflicted skin lesions, and skeletal surveys and funduscopy were not conducted in 14 (38%) and 15 (41%), respectively. Thirteen out of 37 cases (35%) were not reported to hospital-based child protection teams and 22 (59%) were not reported to regional child protective services.
  
  
  CONCLUSIONS
  The sociomedical evaluation of possible child abuse appears to be systematically inadequate in Yokohama.
authors.affiliation: Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Kanagawa, Japan.|Department of Pediatrics, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Sato
authors.affiliation: Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Kanagawa, Japan.|Department of Pediatrics, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kikuchi
authors.affiliation: Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Kanagawa, Japan.|Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Shumpei
authors.initials: S
authors.lastname: Yokota
mesh_terms: D002649:Child Abuse; D002673:Child, Hospitalized; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices
keywords: child abuse; child protection team; child protective service; intracranial hemorrhage; investigation