Landmark perspective: The 'battered child' revisited

Advances in clinical forensic medicine

Clinical forensic medicine is the branch of medicine that deals specifically with cases involving both legal and medical aspects of patient care. A forensic evaluation refers to the detection, collection, and preservation of evidence. Pattern injury recognition, interpretation of injuries, documentation of testimonial and injuries (including photography), reporting requirements, and regulations are all vital components of a forensic evaluation, but are rarely the topic of discussion in training hospitals. Medical professionals working in prehospital care and acute care settings are likely to encounter perplexing forensic issues related to child abuse, sexual assault, or unexpected childhood death in their practice. This article focuses on the most recent insights related to sexual assault and forensic evidence as it relates to successful prosecution, shaken baby syndrome, and pediatric nonaccidental thermal injury. Also reviewed are the most current publications related to clinical forensic medicine for the year 2002, incorporating practical clinical tips from the most informative articles from the past decade.

Child abuse. An update on surgical management in 256 cases

In the period January 1982-July 1984, 1512 cases of suspected child abuse were evaluated in the emergency department of a major children's hospital, of which 256 (17%) required hospitalization. Failure-to-thrive with caloric malnutrition was present in 66 (26%), burns in 56 (22%), central nervous system injury in 53 (22%), soft tissue trauma in 21 (8%), ingestions in 20 (8%), skeletal injury in 15 (6%), neglect of an underlying disease in 10 (4%), sexual abuse in nine (3%), near-drowning in four (1%), and abdominal trauma in two (1%). Two-thirds of the children required surgical care and one-third of the surgical group needed operations. The majority of the patients were toddlers between 18 and 36 months of age. A long hospitalization occurred with a mean stay of 9.3 days. Mortality was 7% for the entire group, but children with central nervous system injury had a much higher mortality (26%) and morbidity (21%).