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Shahi N, Meier M, Reppucci ML, Pickett KL, Phillips R, McLean M, Moulton SL, Lindberg DM. Effect of Routine Child Physical Abuse Screening Tool on Emergency Department Efficiency. Pediatr Emerg Care 2024; 40:509-514. [PMID: 38713842 PMCID: PMC11216854 DOI: 10.1097/pec.0000000000003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVES Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We sought to evaluate the feasibility of routine screening and its effect on length of stay in a network of general EDs. METHODS A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019-10/2/2019 vs 10/3/2019-3/31/2020). The main outcome was ED length of stay in minutes. RESULTS There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, -1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods. CONCLUSIONS Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.
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Affiliation(s)
- Niti Shahi
- Division of Pediatric Surgery, Children’s Hospital Colorado, 13123 E 16 Avenue, Aurora, CO, USA
- Department of Surgery, University of Massachusetts, 55 Lake Avenue North, Worcester, MA, USA
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave #6117, Aurora, CO, USA
| | - Maxene Meier
- The Center for Research in Outcomes for Children’s Surgery, University of Colorado School of Medicine, 13123 E 16th Avenue, Aurora, CO, USA
| | | | - Kaci L. Pickett
- The Center for Research in Outcomes for Children’s Surgery, University of Colorado School of Medicine, 13123 E 16th Avenue, Aurora, CO, USA
| | - Ryan Phillips
- Division of Pediatric Surgery, Children’s Hospital Colorado, 13123 E 16 Avenue, Aurora, CO, USA
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave #6117, Aurora, CO, USA
| | - Marissa McLean
- UCHealth Memorial Hospital Central, 1400 East Boulder Street, Colorado Springs, CO, USA
| | - Steven L. Moulton
- Division of Pediatric Surgery, Children’s Hospital Colorado, 13123 E 16 Avenue, Aurora, CO, USA
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave #6117, Aurora, CO, USA
| | - Daniel M. Lindberg
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, USA
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, , University of Colorado School of Medicine, 13123 E 16th Avenue, B065, Aurora, CO, USA
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Abdoo DC, Puls HT, Hall M, Lindberg DM, Anderst J, Wood JN, Parikh K, Tashijan M, Sills MR. Racial and ethnic disparities in diagnostic imaging for child physical abuse. CHILD ABUSE & NEGLECT 2024; 149:106648. [PMID: 38262182 DOI: 10.1016/j.chiabu.2024.106648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
IMPORTANCE Racial bias may affect occult injury testing decisions for children with concern for abuse. OBJECTIVES To determine the association of race on occult injury testing decisions at children's hospitals. DESIGN In this retrospective study, we measured disparities in: (1) the proportion of visits for which indicated diagnostic imaging studies for child abuse were obtained; (2) the proportion of positive tests. SETTING The Pediatric Health Information System (PHIS) administrative database encompassing 49 tertiary children's hospitals during 2017-2019. PARTICIPANTS We built three cohorts based on guidelines for diagnostic testing for child abuse: infants with traumatic brain injury (TBI; n = 1952), children <2 years old with extremity fracture (n = 20,842), and children <2 years old who received a skeletal survey (SS; n = 13,081). MAIN OUTCOMES AND MEASURES For each group we measured: (1) the odds of receiving a specific guideline-recommended diagnostic imaging study; (2) among those with the indicated imaging study, the odds of an abuse-related injury diagnosis. We calculated both unadjusted and adjusted odds ratios (AOR) by race and ethnicity, adjusting for sex, age in months, payor, and hospital. RESULTS In infants with TBI, the odds of receiving a SS did not differ by racial group. Among those with a SS, the odds of rib fracture were higher for non-Hispanic Black than Hispanic (AOR 2.05 (CI 1.31, 3.2)) and non-Hispanic White (AOR 1.57 (CI 1.11, 2.32)) patients. In children with extremity fractures, the odds of receiving a SS were higher for non-Hispanic Black than Hispanic and non-Hispanic White patients (AOR 1.97 (CI 1.74, 2.23)); (AOR 1.17 (CI 1.05, 1.31)), respectively, and lower for Hispanic than non-Hispanic White patients (AOR 0.59 (CI 0.53, 0.67)). Among those receiving a SS, the rate of rib fractures did not differ by race. In children with skeletal surveys, the odds of receiving neuroimaging did not differ by race. Among those with neuroimaging, the odds of a non-fracture, non-concussion TBI were lower in non-Hispanic Black than Hispanic patients (AOR 0.7 (CI 0.57, 0.86)) and were higher among Hispanic than non-Hispanic White patients (AOR 1.23 (CI 1.02, 1.47)). CONCLUSIONS AND RELEVANCE We did not identify a consistent pattern of race-based disparities in occult injury testing when considering the concurrent yield for abuse-related injuries.
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Affiliation(s)
- Denise C Abdoo
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, United States of America.
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri- Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Matt Hall
- Children's Hospital Association, United States of America
| | - Daniel M Lindberg
- University of Colorado Anschutz Medical Campus, Department of Emergency Medicine, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, United States of America
| | - James Anderst
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri- Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Joanne N Wood
- Division of General Pediatrics, PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States of America
| | | | - Margaret Tashijan
- University of Colorado School of Medicine, Children's Hospital Colorado, United States of America
| | - Marion R Sills
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, United States of America
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Henry MK, Lindberg DM, Campbell KA, Wood JN. Development, contributions, and future directions of a multicenter child abuse research network. Curr Probl Pediatr Adolesc Health Care 2024; 54:101573. [PMID: 38522960 PMCID: PMC11221416 DOI: 10.1016/j.cppeds.2024.101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
CAPNET is a multicenter child abuse pediatrics research network developed to support research that will make the medical care of potentially abused children more effective, safe, and fair. CAPNET currently collects detailed clinical data from child physical abuse evaluations from 11 leading pediatric centers across the U.S. From its inception, the goal of CAPNET was to support multiple research studies addressing the care of children undergoing evaluations for physical abuse and to create a flexible data collection and quality assurance system to be a resource for the wider community of child maltreatment l researchers. Annually, CAPNET collects rich clinical data on over 4000 children evaluated due to concerns for physical abuse. CAPNET's data are well-suited to studies improving the standardization, equity, and accuracy of evaluations in the medical setting when child physical abuse is suspected. Here we describe CAPNET's development, content, lessons learned, and potential future directions of the network.
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Affiliation(s)
- M Katherine Henry
- Division of General Pediatrics, Clinical Futures, and Department of Radiology Children's Hopsital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennslvania, Philadelphia, PA, 19104, USA.
| | - Daniel M Lindberg
- Department of Emergency Medicine, The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, 12631 E. 17(th) Ave. Mailstop C326, Aurora, CO 80045, USA
| | - Kristine A Campbell
- Department of Pediatrics, University of Utah, Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Joanne N Wood
- Division of General Pediatrics, PolicyLab, and Clinical Futures, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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Chen SY, Gao L, Imagawa KK, Roseman ER, Shin CE, Kim ES, Spurrier RG. Screening for Child Abuse in Children With Isolated Skull Fractures. Pediatr Emerg Care 2023; 39:374-377. [PMID: 36018728 DOI: 10.1097/pec.0000000000002823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Head trauma is the most common cause of death from child abuse, and each encounter for recurrent abuse is associated with greater morbidity. Isolated skull fractures (ISF) are often treated conservatively in the emergency department (ED). We determined patterns of physical abuse screening in a children's hospital ED for children with ISF. METHODS A retrospective review was performed for children aged 3 years and younger who presented to the ED with ISF from January 1, 2015 to December 31, 2019. Children were stratified by age (<12 mo, ≥12 mo) and witnessed versus unwitnessed injury. Primary outcome was social work (SW) assessment to prescreen for abuse. Secondary outcomes were suspicion for abuse based on Child Protective Services (CPS) referral and subsequent ED encounters within 1 year. RESULTS Sixty-six ISF patients were identified. Of unwitnessed injury patients aged younger than 12 months (n = 17/22), 88.2% (n = 15/17) underwent SW assessment and 47.1% (n = 8/17) required CPS referral. Of witnessed injury patients aged younger than 12 months (n = 23/44), 60.9% (n = 14/23) underwent SW assessment, with no CPS referrals. Overall, 18.2% (n = 4/22) unwitnessed and 20.5% (n = 9/44) witnessed injury patients returned to our ED: 2 were aged younger than 12 months and had recurrent trauma. CONCLUSIONS To decrease risk of missed physical abuse, SW consultation should be considered for all ISF patients.
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Affiliation(s)
| | | | | | - Eric R Roseman
- Department of Social Work, Children's Hospital Los Angeles
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Mankad K, Sidpra J, Mirsky DM, Oates AJ, Colleran GC, Lucato LT, Kan E, Kilborn T, Agrawal N, Teeuw AH, Kelly P, Zeitlin D, Carter J, Debelle GD, Berger RP, Christian CW, Lindberg DM, Raissaki M, Argyropoulou M, Adamsbaum C, Cain T, van Rijn RR, Silvera VM, Rossi A, Kemp AM, Choudhary AK, Offiah AC. International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child Physical Abuse. JAMA Pediatr 2023; 177:526-533. [PMID: 36877504 DOI: 10.1001/jamapediatrics.2022.6184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Importance Physical abuse is a common but preventable cause of long-term childhood morbidity and mortality. Despite the strong association between abuse in an index child and abuse in contact children, there is no guidance outlining how to screen the latter, significantly more vulnerable group, for abusive injuries. Consequently, the radiological assessment of contact children is often omitted, or variably performed, allowing occult injuries to go undetected and increasing the risk of further abuse. Objective To report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse. Evidence Review This consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts. The modified Delphi consensus process comprised 3 meetings of the International Consensus Group on Contact Screening in Suspected Child Physical Abuse held between February and June 2021. Findings Contacts are defined as the asymptomatic siblings, cohabiting children, or children under the same care as an index child with suspected child physical abuse. All contact children should undergo a thorough physical examination and a history elicited prior to imaging. Contact children younger than 12 months should have neuroimaging, the preferred modality for which is magnetic resonance imaging, and skeletal survey. Contact children aged 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months. Follow-up skeletal survey with limited views should be performed if abnormal or equivocal at presentation. Contacts with positive findings should be investigated as an index child. Conclusions and Relevance This Special Communication reports consensus recommendations for the radiological screening of contact children in the context of suspected child physical abuse, establishing a recognized baseline for the stringent evaluation of these at-risk children and providing clinicians with a more resilient platform from which to advocate for them.
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Affiliation(s)
- Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Developmental Biology and Cancer Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jai Sidpra
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Developmental Biology and Cancer Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora
| | - Adam J Oates
- Department of Radiology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Gabrielle C Colleran
- Department Radiology, Children's Health Ireland and The National Maternity Hospital, Dublin, Ireland
| | - Leandro T Lucato
- Department of Radiology, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil
| | - Elaine Kan
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong
| | - Tracy Kilborn
- Department of Radiology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nina Agrawal
- City University of New York Graduate School of Public Health and Health Policy, New York
| | - Arianne H Teeuw
- Department of Pediatrics, Emma Children's Hospital-Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick Kelly
- Te Puaruruhau, Starship Children's Health, Auckland, New Zealand
- Department of Pediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Deborah Zeitlin
- Department of Pediatrics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jamieson Carter
- Department of Pediatrics, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Geoff D Debelle
- Department of Pediatrics, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Rachel P Berger
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cindy W Christian
- Department of Pediatrics, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daniel M Lindberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Maria Raissaki
- Department of Radiology and Imaging, University Hospital of Heraklion, Medical School, University of Crete, Rethymno, Greece
| | - Maria Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Catherine Adamsbaum
- Paris Saclay University, Faculty of Medicine, AP-HP, Bicêtre Hospital, Department of Paediatric Radiology, Le Kremlin Bicêtre, France
| | - Timothy Cain
- Department of Medical Imaging, Royal Children's Hospital Melbourne, Parkville, Australia
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital-Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, the Netherlands
| | | | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alison M Kemp
- Division of Population Medicine, Department of Child Health, University of Cardiff, Cardiff, United Kingdom
| | - Arabinda K Choudhary
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock
| | - Amaka C Offiah
- Department of Radiology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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6
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Milner JD, Hartnett DA, DeFroda SF, Slingsby BA, Silber ZS, Blackburn AZ, Daniels AH, Cruz AI. Orthopedic manifestations of child abuse. Pediatr Res 2022; 92:647-652. [PMID: 34819655 DOI: 10.1038/s41390-021-01850-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022]
Abstract
Child abuse is common in the United States but is often undetected. The incidence of this form of abuse is difficult to quantify, but children with a history of abuse are at risk of chronic health conditions. Medical providers are in the unique position of triaging trauma patients and differentiating unintentional from abusive trauma, as well as having the important position of being a mandated reporter of abuse in all states. Obtaining a detailed history and screening for risk factors can help identify children at risk of abuse. Certain orthopedic injuries may be related to abuse, which may trigger clinical suspicion and lead to further workup or intervention. By increasing awareness, through medical provider education and increased screening, earlier detection of abuse may prevent more serious injuries and consequences. This review evaluates current literature regarding the orthopedic manifestations of child abuse in hopes of increasing medical provider awareness. IMPACT: Child abuse is common in the United States but often remains undetected. Medical professionals are in the unique position of evaluating trauma patients and identifying concerns for abusive injuries. Certain orthopedic injuries may raise concern for abuse triggering clinical suspicion and further workup or intervention.
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Affiliation(s)
- John D Milner
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, USA.
| | - Davis A Hartnett
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, USA
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, USA
| | - Brett A Slingsby
- Department of Pediatrics, The Lawrence A. Aubin Sr. Child Protection Center, Hasbro Children's Hospital, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, USA
| | - Zachary S Silber
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, USA
| | - Amy Z Blackburn
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, USA
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, USA
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Petska HW, Yin S, Lindberg DM, Beal SJ, Drendel AL, Greiner MV, Wang GS. Drug exposures in young children - The next frontier in occult injury testing. CHILD ABUSE & NEGLECT 2022; 127:105575. [PMID: 35276533 DOI: 10.1016/j.chiabu.2022.105575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Hillary W Petska
- Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Shan Yin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Daniel M Lindberg
- University of Colorado - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Sarah J Beal
- University of Cincinnati College of Medicine, Cincinnati, OH, United States of America; University of Colorado - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Amy L Drendel
- Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Hospital of Wisconsin, Milwaukee, WI, United States of America
| | - Mary V Greiner
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - George Sam Wang
- University of Colorado - Anschutz Medical Campus, Aurora, CO, United States of America
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Cheon JE, Kim JH. Imaging of Abusive Head Trauma : A Radiologists' Perspective. J Korean Neurosurg Soc 2022; 65:397-407. [PMID: 35483021 PMCID: PMC9082130 DOI: 10.3340/jkns.2021.0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/16/2022] [Indexed: 11/27/2022] Open
Abstract
Abusive head trauma (AHT) is the most common and serious form of child abuse and a leading cause of traumatic death in infants and young children. The biomechanics of head injuries include violent shaking, blunt impact, or a combination of both. Neuroimaging plays an important role in recognizing and distinguishing abusive injuries from lesions from accidental trauma or other causes, because clinical presentation and medical history are often nonspecific and ambiguous in this age group. Understanding common imaging features of AHT can increase recognition with high specificity for AHT. In this review, we discuss the biomechanics of AHT, imaging features of AHT, and other conditions that mimic AHT.
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Affiliation(s)
- Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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9
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Henry MK, Schilling S, Shults J, Feudtner C, Katcoff H, Egbe TI, Johnson MA, Andronikou S, Wood JN. Practice Variation in Use of Neuroimaging Among Infants With Concern for Abuse Treated in Children's Hospitals. JAMA Netw Open 2022; 5:e225005. [PMID: 35442455 PMCID: PMC9021910 DOI: 10.1001/jamanetworkopen.2022.5005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Infants who appear neurologically well and have fractures concerning for abuse are at increased risk for clinically occult head injuries. Evidence of excess variation in neuroimaging practices when abuse is suspected may indicate opportunity for quality and safety improvement. OBJECTIVE To quantify neuroimaging practice variation across children's hospitals among infants with fractures evaluated for abuse, with the hypothesis that hospitals would vary substantially in neuroimaging practices. As a secondary objective, factors associated with neuroimaging use were identified, with the hypothesis that age and factors associated with potential biases (ie, payer type and race or ethnicity) would be associated with neuroimaging use. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included infants with a femur or humerus fracture or both undergoing abuse evaluation at 44 select US children's hospitals in the Pediatric Health Information System (PHIS) from January 1, 2016, through March 30, 2020, including emergency department, observational, and inpatient encounters. Included infants were aged younger than 12 months with a femur or humerus fracture or both without overt signs or symptoms of head injury for whom a skeletal survey was performed. To focus on infants at increased risk for clinically occult head injuries, infants with billing codes suggestive of overt neurologic signs or symptoms were excluded. Multivariable logistic regression was used to investigate demographic, clinical, and temporal factors associated with use of neuroimaging. Marginal standardization was used to report adjusted percentages of infants undergoing neuroimaging by hospital and payer type. Data were analyzed from March 2021 through January 2022. EXPOSURES Covariates included age, sex, race and ethnicity, payer type, fracture type, presentation year, and hospital. MAIN OUTCOMES AND MEASURES Use of neuroimaging by CT or MRI. RESULTS Of 2585 infants with humerus or femur fracture or both undergoing evaluations for possible child abuse, there were 1408 (54.5%) male infants, 1726 infants (66.8%) who were publicly insured, and 1549 infants (59.9%) who underwent neuroimaging. The median (IQR) age was 6.1 (3.2-8.3) months. There were 748 (28.9%) Black non-Hispanic infants, 426 (16.5%) Hispanic infants, 1148 (44.4%) White non-Hispanic infants. In multivariable analyses, younger age (eg, odds ratio [OR] for ages <3 months vs ages 9 to <12 months, 13.2; 95% CI, 9.54-18.2; P < .001), male sex (OR, 1.47; 95% CI, 1.22-1.78; P < .001), payer type (OR for public vs private insurance, 1.48; 95% CI, 1.18-1.85; P = .003), fracture type (OR for femur and humerus fracture vs isolated femur fracture, 5.36; 95% CI, 2.11-13.6; P = .002), and hospital (adjusted range in use of neuroimaging, 37.4% [95% CI 21.4%-53.5%] to 83.6% [95% CI 69.6%-97.5%]; P < .001) were associated with increased use of neuroimaging, but race and ethnicity were not. Publicly insured infants were more likely to undergo neuroimaging (62.0%; 95% CI, 60.0%-64.1%) than privately insured infants (55.1%; 95% CI, 51.8%-58.4%) (P = .001). CONCLUSIONS AND RELEVANCE This study found that hospitals varied in neuroimaging practices among infants with concern for abuse. Apparent disparities in practice associated with insurance type suggest opportunities for quality, safety, and equity improvement.
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Affiliation(s)
- M. Katherine Henry
- Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Samantha Schilling
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Justine Shults
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Chris Feudtner
- Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Medical Ethics, Children's Hospital of Philadelphia
| | - Hannah Katcoff
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Teniola I. Egbe
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mitchell A. Johnson
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Savvas Andronikou
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Joanne N. Wood
- Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Metz JB, Otjen JP, Perez FA, Done SL, Brown ECB, Wiester RT, Jenny C, Ganti S, Feldman KW. Fracture-Associated Bruising and Soft Tissue Swelling in Young Children With Skull Fractures: How Sensitive Are They to Fracture Presence? Pediatr Emerg Care 2021; 37:e1392-e1396. [PMID: 32205799 DOI: 10.1097/pec.0000000000002058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine how reliable scalp bruising and soft tissue swelling/cephalohematomas (STS) are for underlying young child skull fractures. METHODS This was a retrospective clinical and imaging review from 2011 to 2012 of children younger than 4 years with skull fractures from 2 tertiary care hospitals. Imaging was reread by 3 pediatric radiologists. Descriptive statistics were utilized. The retrospective review had institutional review board approval. RESULTS We identified 218 subjects for review: 210 unintentional and 8 abusive. One hundred forty-three had available 3-dimensional computed tomography reconstructions: 136 unintentional and 7 abused. Two-thirds were younger than 1 year. Twelve subjects had visible scalp bruising, but 73% had clinically and 93% radiologically apparent fracture-associated STS. There was no difference in clinical STS with simple (79%) versus complex (68%) fractures. Nor was there difference in subjects with fractures from minor (77%) versus major (70%) trauma. Unintentionally injured infants did not differ from abused for detectable STS (74% vs 50%). Parietal and frontal bones most frequently sustained fractures and most consistently had associated STS. CONCLUSIONS Clinically apparent STS is present in approximately three-fourths of children with skull fractures. It may not be important to consistently identify skull fractures in unintentionally injured children. Point-of-care ultrasound may be adequate. For abuse concerns, it is important to identify skull fractures as evidence of cranial impacts and intracranial hemorrhages. The most sensitive, widely available imaging technique, cranial computed tomography scan with 3-dimensional skull reconstruction, should be utilized. Scalp bruising is present in a minority of young children with skull fractures. Its absence does not exclude cranial impact injury.
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Affiliation(s)
- James B Metz
- From the Children's Hospital, Department of Pediatrics, University of Vermont, Burlington, VT
| | | | | | | | - Emily C B Brown
- Children's Protection Program, University of Washington, Seattle Children's Hospital
| | - Rebecca T Wiester
- Children's Protection Program, University of Washington, Seattle Children's Hospital
| | - Carole Jenny
- Children's Protection Program, University of Washington, Seattle Children's Hospital
| | | | - Kenneth W Feldman
- Children's Protection Program, University of Washington, Seattle Children's Hospital
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11
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Daley H, Smith H, McEvedy S, King R, Andrews E, Hawkins F, Guppy N, Kiryazova T, Macleod R, Blake E, Harrison R. Intracranial injuries on computed tomography head scans in infants investigated for suspected physical abuse: a retrospective review. Arch Dis Child 2021; 106:456-460. [PMID: 33122329 DOI: 10.1136/archdischild-2020-319762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND UK national guidelines recommend that investigation of infants (aged <12 months) with suspected physical abuse should always include CT head scans. Such imaging carries small but recognised risks from radiation exposure. Studies report a range of yields for occult intracranial injuries in suspected physical abuse. AIMS To report the yield of intracranial injuries on CT head scans carried out for suspected physical abuse in infants, compare yields for those presenting with or without signs of head injury and to describe selected clinical and radiological features. METHODS A retrospective cross-sectional review of case records of infants undergoing skeletal survey for suspected physical abuse in Wessex, England. The main outcome measure was yield of intracranial injuries on CT head scan. RESULTS In total, n=363 CT head scans were included (n=275 aged <6 months). The overall yield of intracranial injury was 37 (10%). Among 68 infants presenting with neurological signs or skull fractures, yield was 36 (53%) compared with just 1 (0.34%) of 295 without neurological signs or skull fractures. This one intracranial injury was found to be consistent with an accidental fall. Scalp injury was the only additional clinical feature associated with intracranial injury. CONCLUSION In suspected physical abuse, CT head scans should be carried out in infants who present with neurological signs, skull fractures or scalp injuries. However, in balancing potential risks and benefits, we question the value of performing a CT head scan in every infant investigated for suspected physical abuse.
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Affiliation(s)
- Helen Daley
- Department of Community Paediatrics, Solent NHS Trust, Fareham, UK
| | - Hilary Smith
- Department of Community Paediatrics, Solent NHS Trust, Fareham, UK
| | - Samantha McEvedy
- The Academy of Research and Improvement, Solent NHS Trust, Portsmouth, UK
| | - Rachel King
- Department of Paediatrics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
| | - Edward Andrews
- Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Faye Hawkins
- Department of Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicole Guppy
- Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Todorka Kiryazova
- Department of Paediatrics, Isle of Wight NHS Trust, Newport, Isle of Wight, UK
| | - Rebecca Macleod
- Department of Paediatrics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
| | - Emma Blake
- Department of Paediatrics, Isle of Wight NHS Trust, Newport, Isle of Wight, UK
| | - Rachael Harrison
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
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12
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Glenn K, Nickerson E, Bennett CV, Naughton A, Cowley LE, Morris E, Murtagh U, Kontos K, Kemp AM. Head computed tomography in suspected physical abuse: time to rethink? Arch Dis Child 2021; 106:461-466. [PMID: 33122332 DOI: 10.1136/archdischild-2020-320192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND National guidance recommends CT-head for all children <1 year old with suspected physical abuse, and to be considered for those <2 years old to exclude abusive head trauma. OBJECTIVES To investigate whether this guidance is followed, and the associations between clinical presentation and CT findings, to determine whether guidance could be refined. MATERIALS AND METHODS A retrospective case note review of all children <2 years old who underwent medical assessment for suspected abuse (2009-2017). Outcome measures were frequency of CT-head, and diagnostic yield of intracranial injury, skull fracture or both. RESULTS CT-head was undertaken in 60.3% (152/252) of children <12 months old and 7.8% (13/167) of those aged 12-24 months. The diagnostic yield in children who had a CT-head was 27.1% in children <6 months old, 14.3% in those 6-12 months old (p=0.07) and 42.6% (6/13) in those 12-24 months old. For those with head swelling or neurological impairment, it was 84.2% (32/38). In children <12 months old without these clinical features, the estimated prevalence of occult head injury was 6.1% (7/115). The strongest predictors of an abnormal CT-head were swelling to the head (OR 46.7), neurological impairment (OR 20.6) and a low haemoglobin (OR 11.8). CONCLUSION All children <2 years of age with suspected physical abuse and neurological impairment or head swelling should undergo CT-head. Where the technical skills and the requisite expertise to interpret MRI exist, an MRI scan may be the optimal first-line neuroimaging investigation in infants who are neurologically stable with injuries unrelated to the head to minimise cranial radiation exposure.
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Affiliation(s)
- Kathryn Glenn
- Department of Community Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Elizabeth Nickerson
- Department of Community Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - C Verity Bennett
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | | | - Emily Morris
- Department of Community Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Una Murtagh
- Department of Community Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katina Kontos
- Department of Community Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alison Mary Kemp
- Division of Population Medicine, Cardiff University College of Biomedical and Life Sciences, Cardiff, UK
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13
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Crumm CE, Brown EC, Thomas-Smith S, Yu DT, Metz JB, Feldman KW. Evaluation of an Emergency Department High-risk Bruising Screening Protocol. Pediatrics 2021; 147:peds.2020-002444. [PMID: 33653877 PMCID: PMC8015159 DOI: 10.1542/peds.2020-002444] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe the outcomes of implementing a high-risk bruise screening pathway in a pediatric emergency department (ED). METHODS A retrospective observational study was performed of children aged 0 to <48 months who presented to the ED between December 1, 2016, and April 1, 2019, and had bruising that is high-risk for physical abuse on a nurse screening examination. A high-risk bruise was defined as any bruise if aged <6 months or a bruise to the torso, ears, or neck if aged 6 to <48 months. Records of children with provider-confirmed high-risk bruising were reviewed. RESULTS Of the 49 726 age-eligible children presenting to the ED, 43 771 (88%) were screened for bruising. Seven hundred eighty-three (1.8%) of those children had positive screen results and 163 (0.4%) had provider-confirmed high-risk bruising. Of the 8635 infants aged <6 months who were screened, 48 (0.6%) had high-risk bruising and 24 of 48 (50%) were classified as cases of likely or definite abuse. Skeletal surveys were performed in 29 of 48 (60%) infants, and 11 of 29 (38%) had occult fracture. Of the 35 136 children aged 6 to <48 months who were screened, 115 of 35 136 (0.3%) had high-risk bruising and 32 of 115 (28%) were classified as cases of likely or definite abuse. CONCLUSIONS High-risk bruising was rarely present. When infants aged <6 months were evaluated per recommendations, occult fracture was identified in one-third of patients. The screening pathway could help other institutions identify occult injuries in pediatric ED patients.
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Affiliation(s)
- Caitlin E. Crumm
- Seattle Children’s Hospital and,Divisions of General Pediatrics and
| | - Emily C.B. Brown
- Seattle Children’s Hospital and,Divisions of General Pediatrics and
| | - Siobhan Thomas-Smith
- Seattle Children’s Hospital and,Emergency Medicine, Department of Pediatrics, University of Washington, Seattle, Washington; and
| | - Daniel T.Y. Yu
- Seattle Children’s Hospital and,Divisions of General Pediatrics and
| | - James B. Metz
- Divisions of Pediatric Hospitalist Medicine and Child Abuse Pediatrics, Department of Pediatrics, The University of Vermont Children’s Hospital, Burlington, Vermont
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Chahla S, Ortega H. Intracranial Injury Among Children with Abuse-Related Long Bone Fractures. J Emerg Med 2020; 59:735-743. [PMID: 32682640 PMCID: PMC7364151 DOI: 10.1016/j.jemermed.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/13/2020] [Accepted: 06/01/2020] [Indexed: 11/03/2022]
Abstract
Background Objectives Methods Results Conclusions
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15
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Henry MK, Lindberg DM, Wood JN. More data, more questions: No simple answer about which children should undergo screening neuroimaging for clinically occult abusive head trauma. CHILD ABUSE & NEGLECT 2020; 107:104561. [PMID: 32544698 DOI: 10.1016/j.chiabu.2020.104561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
Abusive head trauma (AHT) is the leading cause of fatal child physical abuse. Victims may initially present with clinically occult AHT without overt signs of head trauma or with only subtle, nonspecific symptoms, which can make timely recognition of AHT challenging. Research has shown missed opportunities for early detection of AHT in the medical setting are common and can lead to repeated injury. Neuroimaging is needed to diagnose clinically occult AHT but is not without risk. Researchers have worked to understand the yield of neuroimaging in detection of clinically occult AHT and to identify risk factors, yet findings have varied widely across studies. Identifying which children undergoing physical abuse evaluations are at highest risk of clinically occult AHT is key to development of evidence-based imaging decision support tools for clinicians. Here we discuss the recent literature, identify potential reasons for variation across studies, and offer opportunities for future research.
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Affiliation(s)
- M Katherine Henry
- Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Daniel M Lindberg
- Department of Emergency Medicine, University of Colorado School of Medicine. 12401 E. 17th Ave., Aurora, CO 80238, United States; The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, 12401 E. 17th Ave., Aurora, CO 80238, United States
| | - Joanne N Wood
- Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; PolicyLab, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, United States
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16
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Henry MK, Feudtner C, Fortin K, Lindberg DM, Anderst JD, Berger RP, Wood JN. Occult head injuries in infants evaluated for physical abuse. CHILD ABUSE & NEGLECT 2020; 103:104431. [PMID: 32143091 PMCID: PMC7276264 DOI: 10.1016/j.chiabu.2020.104431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Abusive head injuries in infants may be occult but clinically or forensically important. Data conflict regarding yield of neuroimaging in detecting occult head injuries in infants evaluated for physical abuse, with prior studies identifying yields of 4.3-37.3 %. OBJECTIVES (1) To quantify yield of computed tomography or magnetic resonance imaging in identification of occult head injuries in infants with concerns for physical abuse and (2) to evaluate risk factors for occult head injuries. PARTICIPANTS AND SETTING We conducted a retrospective, stratified, random systematic sample of 529 infants <12 months evaluated for physical abuse at 4 urban children's hospitals in the United States from 2008-2012. Infants with signs or symptoms suggesting head injury or skull fracture on plain radiography (N = 359), and infants without neuroimaging (N = 1) were excluded. METHODS Sampling weights were applied to calculate proportions of infants with occult head injuries. We evaluated for associations between hypothesized risk factors (age <6 months, rib or extremity fracture, facial bruising) and occult head injury using chi-square tests. RESULTS Of 169 neurologically normal infants evaluated for abuse, occult head injury was identified in 6.5 % (95 % CI: 2.6, 15.8). Infants <6 months were at higher risk (9.7 %; 95 % CI: 3.6, 23.3) than infants 6-12 months (1.0 %; 95 % CI: 1.3, 20.2). Rib fracture, extremity fracture and facial bruising were not associated with occult head injury. CONCLUSIONS Occult head injuries were less frequent than previously reported in some studies, but were identified in 1 in 10 infants <6 months. Clinicians should have a low threshold to obtain neuroimaging in young infants with concern for abuse.
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Affiliation(s)
- M Katherine Henry
- Division of General Pediatrics, Children's Hospital of Philadelphia, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States.
| | - Chris Feudtner
- Division of General Pediatrics, Children's Hospital of Philadelphia, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States
| | - Kristine Fortin
- Division of General Pediatrics, Children's Hospital of Philadelphia, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States
| | - Daniel M Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, 12401 E. 17(th) Ave. Aurora, CO, 80238, United States
| | - James D Anderst
- Department of Pediatrics, Division of Child Adversity and Resilience, University of Missouri Kansas City School of Medicine and Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, United States
| | - Rachel P Berger
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Safar Center for Resuscitation Research, University of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States
| | - Joanne N Wood
- Division of General Pediatrics, Children's Hospital of Philadelphia, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA, 19104, United States; PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, United States
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17
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Rao R, Browne D, Lunt B, Perry D, Reed P, Kelly P. Radiation doses in diagnostic imaging for suspected physical abuse. Arch Dis Child 2019; 104:863-868. [PMID: 30995983 DOI: 10.1136/archdischild-2018-316286] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/21/2019] [Accepted: 03/28/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To measure the actual radiation dose delivered by imaging techniques commonly used in the radiography of suspected physical abuse and to make this information available to health professionals and families. METHODS Data were collected retrospectively on children under 3 years referred for skeletal surveys for suspected physical abuse, non-contrast CT head scan or radionuclide imaging of the bones in Starship Children's Hospital, Auckland, New Zealand from January to December 2015. Patient size-specific conversion coefficients were derived from International Commission on Radiologic Protection tissue weighting factors and used to calculate effective dose. RESULTS Seventy-one patients underwent an initial skeletal survey, receiving a mean effective dose of 0.20 mSv (95% CI 0.18 to 0.22). Sixteen patients had a follow-up survey with a mean effective dose of 0.10 mSv (95% CI 0.08 to 0.11). Eighty patients underwent CT head which delivered a mean effective dose of 2.49 mSv (95% CI 2.37 to 2.60). Thirty-nine patients underwent radionuclide bone imaging which delivered a mean effective dose of 2.27 mSv (95% CI 2.11 to 2.43). CONCLUSIONS In a paediatric centre, skeletal surveys deliver a relatively low effective radiation dose, equivalent to approximately 1 month of background radiation. Non-contrast CT head scan and radionuclide bone imaging deliver similar doses, equivalent to approximately 1 year of background radiation. This information should be considered when gaining informed consent and incorporated in patient education handouts.
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Affiliation(s)
- Raylene Rao
- Te Puaruruhau (Child Protection Team), Starship Children's Health, Auckland, New Zealand
| | - Diana Browne
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand
| | - Brian Lunt
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand.,Auckland City Hospital, Department of Nuclear Medicine, Auckland, New Zealand
| | - David Perry
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand
| | - Peter Reed
- Children's Research Centre, Starship Children's Health, Auckland, New Zealand
| | - Patrick Kelly
- Te Puaruruhau (Child Protection Team), Starship Children's Health, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
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18
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Clinically occult abusive head trauma: which age group should we screen? Pediatr Radiol 2019; 49:1378-1379. [PMID: 31352513 DOI: 10.1007/s00247-019-04477-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 06/20/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
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Stone EL, Davis LL. State of the Science: Skull Fracture and Intracranial Injury in Children Below Age 2. J Emerg Nurs 2019; 45:545-550. [PMID: 31053239 DOI: 10.1016/j.jen.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/19/2019] [Accepted: 03/29/2019] [Indexed: 11/28/2022]
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