Prior opportunities to identify abuse in children with abusive head trauma.
Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included. A prior opportunity was defined as prior evaluation by either a medical or child protective services (CPS) professional when the symptoms and/or referral could be consistent with abuse but the diagnosis was not made and/or an alternate explanation was given and accepted. Two-hundred-thirty-two children with AHT were identified; median age (IQR) was 5.40 (3.30, 14.60) months. Ten percent (22/232) died. Of the 232 patients diagnosed with AHT, 31% (n=73) had a total of 120 prior opportunities. Fifty-nine children (25%) had at least one prior opportunity to identify abuse in a medical setting, representing 98 prior opportunities. An additional 14 (6%) children had 22 prior opportunities through previous CPS involvement. There were no differences between those with and without a prior opportunity based on age, gender, race, insurance, mortality, or institution. Children with prior opportunities in a medical setting were more likely to have chronic subdural hemorrhage (48 vs. 17%, p<0.01) and healing fractures (31 vs. 19%, p=0.05). The most common prior opportunities included vomiting 31.6% (38/120), prior CPS contact 20% (24/120), and bruising 11.7% (14/120). Improvements in earlier recognition of AHT and subsequent intervention might prevent additional injuries and reduce mortality.
Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; The Ohio State University College of Medicine, 370 W. 9th Ave., Columbus, OH 43210, USA. Electronic address: megan.letson@nationwidechildrens.org.
Megan M
MM
Letson
Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
Jennifer N
JN
Cooper
Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; The Ohio State University College of Medicine, 370 W. 9th Ave., Columbus, OH 43210, USA.
Katherine J
KJ
Deans
The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Building 421, Philadelphia, PA 19104, USA.
Philip V
PV
Scribano
Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA.
Kathi L
KL
Makoroff
Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; University of Washington School of Medicine, 4333 Brooklyn Ave. NE, Seattle, WA 98105, USA.
Kenneth W
KW
Feldman
Children's Hospital of Pittsburgh of UPMC, 4401 Penn Ave., Pittsburgh, PA 15224, USA; Safar Center for Resuscitation Research, 3434 Fifth Ave., University of Pittsburgh 15260, USA.
Rachel P
RP
Berger
D002649:Child Abuse / Q000175:diagnosis*; D000068216:Child Protective Services; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies; D018571:Sentinel Surveillance
Abusive head trauma; Child physical abuse; Sentinel injuries