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Arneitz C, Schmitz J, Szilagyi I, Kienesberger B, Schalamon G, Senica SO, Schalamon J. Abusive head trauma and crying infant-Public awareness of newborn and infant trauma. Acta Paediatr 2024; 113:1569-1578. [PMID: 38634613 DOI: 10.1111/apa.17243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
AIM Crying seems to be a common trigger for abusive head trauma (AHT), which is the leading cause of fatalities from physical abuse in infants. Our objective was to evaluate knowledge of AHT, crying infants and correct behavioural measures in a general population. METHODS An online questionnaire (LimeSurvey) was created to assess the risk of shaking. The online survey contained a total of 41 questions, including a demonstration of a previously recorded video in which an infant doll is shaken. RESULTS A total of 319 people, 245 of them (76.8%) with own children, participated in the study. Almost all respondents (98.4%) were aware of serious injuries due to shaking, even to the point of death (98.1%). Most participants (97.5%) had heard the term 'shaking trauma' prior but did not receive any professional information, neither before nor after birth (85.2% or 86%), or during follow-up examinations (88.5%). The majority of the participants (95%) considered that useful coping strategies in infant crying were inappropriate. CONCLUSION The consequences of shaking an infant were common knowledge in a normal population, whereas there was a knowledge gap regarding the management of excessive crying infants. Prevention programmes should mainly focus on male caregivers during postnatal care.
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Affiliation(s)
- Christoph Arneitz
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
- Safe Kids Austria, Carinthian Branch, Klagenfurt, Austria
| | - Jana Schmitz
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Istvan Szilagyi
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Bernhard Kienesberger
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
| | - Georg Schalamon
- Department of Trauma Surgery, Clinic Diakonissen Schladming, Teaching Hospital of the Paracelsus Medical University, Schladming, Austria
| | - Simone Oliver Senica
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
| | - Johannes Schalamon
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
- Safe Kids Austria, Carinthian Branch, Klagenfurt, Austria
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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2
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Sribnick EA, Leonard JC, Leonard JR. Limitations to Assessing Withdrawal of Care in Children. JAMA Surg 2024; 159:296. [PMID: 38117511 DOI: 10.1001/jamasurg.2023.6539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Eric A Sribnick
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Surgery, Division of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus
| | - Julie C Leonard
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey R Leonard
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Surgery, Division of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus
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Dean JR, Kaczor K, Lorenz D, Mason M, Simonton K. Characteristics of child abuse fatalities: Insights from a statewide violent death reporting system. CHILD ABUSE & NEGLECT 2024; 149:106649. [PMID: 38295604 DOI: 10.1016/j.chiabu.2024.106649] [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: 09/25/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Child maltreatment fatalities are a significant public health issue. Case level characteristics of abuse-related deaths can increase our understanding of maltreatment fatalities and inform region-specific prevention initiatives. OBJECTIVE Explore child abuse fatalities in the Illinois Violent Death Reporting System (IVDRS) for commonalities and distinctive features. METHODS, PARTICIPANTS AND SETTING A mixed methods study was conducted using IVDRS data from 2015 to 2018. All fatalities with a homicide or undetermined manner of death among decedents 10 years old or younger were included. Both discrete and narrative data were analyzed separately for victim, suspect, circumstance, and household characteristics. RESULTS Of the 106 deaths that met inclusion criteria, 74 % of homicide deaths (64/86) and 50 % of undetermined deaths (10/20) were due to abuse. Psychosocial characteristics most often identified in abusive deaths included family relationship problems, mental illness, and history of substance abuse. Other common characteristics included use of personal weapons or blunt instruments and death due to punishment. Including narrative data rather than discrete data alone identified 148 % more deaths with three characteristics commonly found in abusive deaths: history of abuse, shaken baby syndrome, and family history of violence. CONCLUSION This study demonstrates the capability of multi-source state-level data to enrich our understanding of child abuse fatalities. Employing the narrative review method in other states using the National Violent Death Reporting System may increase the identification of abuse fatalities. Improved recognition and characterization of abuse fatalities has the potential to help address systemic factors involved and enhance targeted prevention efforts. WHAT IS KNOWN Child abuse fatalities represent a significant and preventable public health issue in the United States. Case-specific characteristics are limited in national data sets, and their absence curtails prevention opportunities. WHAT THIS STUDY ADDS State-wide reporting systems of violent deaths offer rich and multisource data regarding child abuse fatalities including detailed victim, suspect, circumstance, and household characteristics. This data can be used to enhance our knowledge of maltreatment fatalities and may inform region-specific public health and prevention initiatives.
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Affiliation(s)
- Julie Robin Dean
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Kim Kaczor
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA.
| | - Doug Lorenz
- Department of Bioinformatics and Biostatistics, University of Louisville, 485 E. Gray St. Louisville, KY 40202, USA.
| | - Maryann Mason
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Kirsten Simonton
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA.
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Batra EK, Quinlan K, Palusci VJ, Needelman H, Collier A. Child Fatality Review. Pediatrics 2024; 153:e2023065481. [PMID: 38374813 DOI: 10.1542/peds.2023-065481] [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] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
Understanding why children die is necessary to implement strategies to prevent future deaths and improve the health of any community. Child fatality review teams (CFRTs) have existed since the 1970s and provide a necessary framework to ensure that proper questions are asked about a child's death. CFRTs provide a vital function in a community to ensure that preventable causes of deaths are identified. Pediatricians are necessary members of CFRTs because they provide medical expertise and context around a child's death. All CFRTs should have pediatric physician representation, and results from team meetings should inform public policy at all levels of government. Pediatricians should be supported in their efforts to be present on CFRTs, and they should use data from team meetings to help advocate for implementing prevention strategies.
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Affiliation(s)
- Erich K Batra
- Departments of Pediatrics, and Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Vincent J Palusci
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Howard Needelman
- Department of Developmental Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Abby Collier
- National Center for Fatality Review and Prevention at MPHI, Okemos, Michigan
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Chang HY, Chang YC, Chang YT, Chen YW, Wu PY, Feng JY. The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:354-368. [PMID: 36762510 DOI: 10.1177/15248380231151690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs' pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants' inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents' knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents' emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.
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Affiliation(s)
- Hsin-Yi Chang
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan
| | - Yu-Chun Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei
| | - Yi-Ting Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan
| | - Yi-Wen Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Pei-Yu Wu
- School of Nursing, College of Medicine, National Taiwan University, Taipei
| | - Jui-Ying Feng
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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Fortin V, Ortiz ARDA, Marq AD, Mostermans E, Marichal M, Bailhache M. Childminder knowledge of shaken baby syndrome and the role played by childminders in prevention: An observational study in France. Arch Pediatr 2024; 31:54-58. [PMID: 37940506 DOI: 10.1016/j.arcped.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/07/2023] [Accepted: 09/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Shaken baby syndrome (SBS) triggers negative short- and long-term outcomes. In France, registered childminders are the principal source of daycare. They may encounter SBS imparted by caregivers or simply excessive infant crying. The aim of the study was to explore childminder knowledge on SBS, the source of information, the responses to infant crying, how childminders perceived their roles in terms of caregiver SBS prevention, and the factors associated with a good knowledge of SBS. METHODS The participants were registered childminders working in the French department of Gironde who had email accounts. This observational study employed an anonymous online questionnaire distributed by the maternal and child health services unit of the Gironde department over 5 weeks from 16 September 2021. Data on childminder characteristics, knowledge on SBS, responses to infant crying, and perceptions of their roles in SBS prevention were collected. The knowledge score ranged from 0 (all wrong answers) to 30 (all correct answers). RESULTS A total of 779 registered childminders participated; 43.9 % had learnt about SBS during their initial training and 75 % before (other training) or after initial training. The median knowledge score was 19/30 (interquartile range [16; 21]). A higher educational level, previous other professional experience, training on SBS, and responsibility for few children were associated with higher scores. Ten reported that they did not advise caregivers who complained of infant crying. CONCLUSION Childminders require training on SBS and SBS prevention.
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Affiliation(s)
- Valentine Fortin
- CHU de Bordeaux, Midwifery School, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | | | - Anne-Dominique Marq
- Conseil Départemental Gironde, Direction de la promotion de la Santé, service PMI Enfance CD33, 33074 Bordeaux, France
| | - Emmanuelle Mostermans
- Conseil Départemental Gironde, Direction de la promotion de la Santé, service PMI Enfance CD33, 33074 Bordeaux, France
| | - Myriam Marichal
- CHU de Bordeaux, Pole de Santé Publique, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | - Marion Bailhache
- CHU de Bordeaux, Pole de pediatrie, Place Amélie Raba Léon, F-33000 Bordeaux, France; Univ. Bordeaux, Bordeaux, France; Bordeaux Population Health Research Center, INSERM U1219, Bordeaux, France.
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Guterman NB, Bellamy JL, Banman A, Harty JS, Jaccard J, Mirque-Morales S. Engaging fathers to strengthen the impact of early home visitation on physical child abuse risk: Findings from the dads matter-HV randomized controlled trial. CHILD ABUSE & NEGLECT 2023; 143:106315. [PMID: 37419071 DOI: 10.1016/j.chiabu.2023.106315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Despite growing recognition of the importance of fathers in child abuse risk, the field of perinatal home visitation has only begun to consider fathers' roles in the implementation of such services. OBJECTIVES This study examines the effectiveness of Dads Matter-HV ("DM-HV"), a father-inclusion enhancement to home visitation, and hypothesized mediators of impact. METHODS A multisite cluster randomized controlled trial was conducted with 17 home visiting program teams serving 204 families across study conditions. Program supervisors and their teams were randomized to deliver home visiting services plus DM-HV enhanced services (intervention) or home visiting services alone (control). Data were collected at three time points: baseline, 4 months post-baseline immediately following the intervention, and 12 months post-baseline. We employed structural equation modeling to estimate the effect of the intervention on physical child abuse risk and to trace hypothesized mediators, including the quality of the father-worker relationship, parents' partner support and abuse, and the timing of service initiation. RESULTS Results indicated that the DM-HV enhancement improved home visitor relationships with fathers, but only for families receiving services initiated postnatally. For these families, the improved quality of the father-worker relationship predicted improved parents' support of one another and reduced bidirectional mother-father partner abuse at 4-month follow-up, which in turn lowered maternal physical child abuse risk and paternal physical child abuse risk at 12-month follow-up. CONCLUSIONS DM-HV can strengthen the impact of home visitation services on physical child abuse risk for families when services are initiated postnatally.
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Affiliation(s)
- Neil B Guterman
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA.
| | - Jennifer L Bellamy
- Graduate School of Social Work, University of Denver, 2148 South High Street, Denver, CO 80208, USA
| | - Aaron Banman
- Grace Abbott School of Social Work, University of Nebraska Omaha, 6001 Dodge Street, Omaha, NE, 68182, USA
| | - Justin S Harty
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 411 N Central Ave #750, Phoenix, AZ 85004, USA
| | - James Jaccard
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA
| | - Sandra Mirque-Morales
- Center for Clinical and Translational Science, 1747 Roosevelt Road, WROB Room 216, Chicago, IL, 60608, USA
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8
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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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Crouch JL, Bridgett DJ, Milner JS, Cote K, Lelakowska G, Davila A, McKay E, Savoree S. Prolonged Infant Crying: Caregiving Quality and Child Physical Abuse Risk. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:3298-3320. [PMID: 35654573 DOI: 10.1177/08862605221106137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Research suggests that prolonged infant crying may increase risk for child physical abuse (CPA). However, few studies have examined behavioral responses to infant crying among parents at risk for CPA. The present study sought to fill this gap by using a simulated infant to examine how mothers and fathers with varying degrees of CPA risk respond to prolonged infant crying. Specifically, a sample of 184 general population caregivers (107 mothers and 77 fathers) participated in a task that involved attempting to soothe a simulated infant that cried continuously for 30 min. The simulated infant sessions were video-recorded, and quality of caregiving behavior was coded in 5-min segments. Participants rated their negative affect (feelings of upset, distress, irritability) at the outset of the data collection session, before beginning the simulated infant task, and after the simulated infant task concluded. It was predicted that high-risk caregivers, compared to low-risk caregivers, would display lower quality caregiving, higher levels of negative affect, and that CPA risk group differences would increase over time. Gender differences were explored in relation to the aforementioned hypotheses. Over the course of the 30-min simulated infant task, the quality of caregiving behavior diminished among both high- and low-risk caregivers. As expected, high-risk caregivers, compared to low-risk caregivers, exhibited lower quality caregiving behaviors and were more likely to discontinue the simulated infant task early. In addition, high-risk, compared to low-risk, caregivers reported higher levels of negative affect throughout the data collection session, with the highest level of negative affect reported by high-risk caregivers after completing the simulated infant task. Overall, the quality of caregiving exhibited by men and women did not significantly differ. The present findings highlight the importance of early intervention designed to support caregivers' abilities to respond effectively to prolonged infant crying.
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Affiliation(s)
- Julie L Crouch
- Center for the Study of Family Violence and Sexual Assault, 2848Northern Illinois University, DeKalb, IL, USA
| | - David J Bridgett
- Center for the Study of Family Violence and Sexual Assault, 2848Northern Illinois University, DeKalb, IL, USA
| | - Joel S Milner
- Center for the Study of Family Violence and Sexual Assault, 2848Northern Illinois University, DeKalb, IL, USA
| | - Kreila Cote
- Center for the Study of Family Violence and Sexual Assault, 2848Northern Illinois University, DeKalb, IL, USA
| | - Gabriela Lelakowska
- Center for the Study of Family Violence and Sexual Assault, 2848Northern Illinois University, DeKalb, IL, USA
| | - America Davila
- Center for the Study of Family Violence and Sexual Assault, 2848Northern Illinois University, DeKalb, IL, USA
| | - Erin McKay
- Center for the Study of Family Violence and Sexual Assault, 2848Northern Illinois University, DeKalb, IL, USA
| | - Shelby Savoree
- Center for the Study of Family Violence and Sexual Assault, 2848Northern Illinois University, DeKalb, IL, USA
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Matsumura K, Hamazaki K, Tsuchida A, Inadera H. Omega-3 fatty acid intake during pregnancy and risk of infant maltreatment: a nationwide birth cohort - the Japan Environment and Children's Study. Psychol Med 2023; 53:995-1004. [PMID: 34176535 PMCID: PMC9975990 DOI: 10.1017/s0033291721002427] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intake of omega-3 polyunsaturated fatty acids (PUFAs) has favorable effects, including reducing violent and aggressive behaviors, but its association with infant maltreatment is unknown. We therefore tested the hypothesis that maternal intake of omega-3 PUFAs is associated with a lower risk of infant maltreatment. METHODS Participants were 92 191 mothers involved in the ongoing Japan Environment and Children's Study. Omega-3 PUFA intake during pregnancy was measured using a food frequency questionnaire. Infant maltreatment was assessed using a self-reported questionnaire administered at 1 and 6 months postpartum. RESULTS Analysis using the lowest quintile of intake as a reference revealed that the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for cases of 'hitting' decreased as quintiles increased, with values for the second to fifth quintiles of 0.93 (95% CI 0.77-1.13), 0.79 (95% CI 0.64-0.97), 0.78 (95% CI 0.64-0.96), and 0.72 (95% CI 0.59-0.89), respectively. Adjusted ORs (95% CIs) for 'shaking very hard' at 6 months were 0.87 (0.73-1.04), 0.81 (0.67-0.97), 0.73 (0.61-0.89), and 0.78 (0.65-0.94), respectively. Adjusted ORs for 'leaving alone at home' for the second to fifth quintiles were 0.92 (0.87-0.98), 0.91 (0.86-0.97), 0.94 (0.88-0.99), and 0.85 (0.80-0.90), respectively. CONCLUSIONS Higher maternal intake of omega-3 PUFAs during pregnancy was associated with fewer cases of hitting and violent shaking and leaving the child alone at home, implying a lower risk of infant maltreatment. Our results indicate the potential applicability of omega-3 PUFAs in reducing infant maltreatment.
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Affiliation(s)
- Kenta Matsumura
- Toyama Regional Center for Japan Environment and Children's Study, University of Toyama, Toyama, Japan
| | - Kei Hamazaki
- Toyama Regional Center for Japan Environment and Children's Study, University of Toyama, Toyama, Japan
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Department of Public Health, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Akiko Tsuchida
- Toyama Regional Center for Japan Environment and Children's Study, University of Toyama, Toyama, Japan
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hidekuni Inadera
- Toyama Regional Center for Japan Environment and Children's Study, University of Toyama, Toyama, Japan
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
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11
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Palusci VJ, Schnitzer PG, Collier A. Social and demographic characteristics of child maltreatment fatalities among children ages 5-17 years. CHILD ABUSE & NEGLECT 2023; 136:106002. [PMID: 36621053 DOI: 10.1016/j.chiabu.2022.106002] [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: 08/08/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND While risk factors have been identified among infants and young children, less is known about child maltreatment fatalities among older children. OBJECTIVES To describe the social and demographic characteristics of children where abuse or neglect was determined to cause or contribute to their death, compare characteristics and circumstances of the deaths by cause and manner of death and type of maltreatment, and explore the role of abuse and neglect in child suicides. PARTICIPANTS AND SETTING Secondary analysis of deaths due to child abuse or neglect among children ages 5-17 years old occurring during 2009-2018 and documented in the National Fatality Review-Case Reporting System. METHODS Child, family, and social characteristics were compared by child age (5-10 years vs. 11-17 year-olds), and by cause and manner of death. Frequencies and proportions were reported and compared using chi-square statistics. RESULTS 1478 maltreatment-related deaths were identified. Higher proportions of older children were non-Hispanic white, had a history of chronic disease or disability, had problems in school, and had a history of mental health issues. Forty-three percent of the maltreatment deaths were due to homicide and 10 % by suicide. Higher proportions (65 %) of younger children (5-10 years old) died by homicide, compared to older children (35 % among ages 11-17y). While 58 % of deaths overall were related to neglect, 68 % of deaths in older children were related to neglect, including 80 % of suicides. CONCLUSIONS The causes of child maltreatment deaths among children 5-17y vary by age. Child neglect caused and/or contributed to most child suicides.
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Affiliation(s)
| | - Patricia G Schnitzer
- U.S. National Center for Child Fatality Review and Prevention, a program of the Michigan Public Health Institute, Okemos, MI, USA
| | - Abigael Collier
- U.S. National Center for Child Fatality Review and Prevention, a program of the Michigan Public Health Institute, Okemos, MI, USA
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Sayrs LW, Ortiz JB, Notrica DM, Kirsch L, Kelly C, Stottlemyre R, Cohen A, Misra S, Green TR, Adelson PD, Lifshitz J, Rowe RK. Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP6785-NP6812. [PMID: 33092447 DOI: 10.1177/0886260520967151] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Over half of fatal pediatric traumatic brain injuries are estimated to be the result of physical abuse, i.e., abusive head trauma (AHT). Although intimate partner violence (IPV) is a well-established risk for child maltreatment, little is known about IPV as an associated risk factor specifically for AHT. We performed a single-institution, retrospective review of all patients (0-17 years) diagnosed at a Level 1 pediatric trauma center with head trauma who had been referred to an in-hospital child protection team for suspicion of AHT between 2010 and 2016. Data on patient demographics, hospitalization, injury, family characteristics, sociobehavioral characteristics, physical examination, laboratory findings, imaging, discharge, and forensic determination of AHT were extracted from the institution's forensic registry. Descriptive statistics (mean, median), chi-square and Mann-Whitney U tests were used to compare patients with fatal head injuries to patients with nonfatal head injuries by clinical characteristics, family characteristics, and forensic determination. Multiple logistic regression was used to estimate adjusted odds ratios for the presence of IPV as an associated risk of AHT while controlling for other clinical and family factors. Of 804 patients with suspicion for AHT in the forensic registry, there were 240 patients with a forensic determination of AHT; 42 injuries were fatal. There were 101 families with a reported history of IPV; 64.4% of patients in families with reported IPV were <12 months of age. IPV was associated with a twofold increase in the risk of AHT (Exp(β) = 2.3 [p = .02]). This study confirmed IPV was an associated risk factor for AHT in a single institution cohort of pediatric patients with both fatal and nonfatal injuries. Identifying IPV along with other family factors may improve detection and surveillance of AHT in medical settings and help reduce injury, disability, and death.
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Affiliation(s)
- Lois W Sayrs
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - J Bryce Ortiz
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - David M Notrica
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Lisa Kirsch
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Cara Kelly
- Phoenix Children's Hospital, Phoenix, AZ, USA
- Arizona State University School of Social Work, Phoenix, AZ, USA
| | | | - Aaron Cohen
- Valleywise Health Medical Center, Phoenix, AZ, USA
| | - Shivani Misra
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Tabitha R Green
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - P David Adelson
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Jonathan Lifshitz
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, USA
| | - Rachel K Rowe
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, USA
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13
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Caré MM. Parenchymal Insults in Abuse—A Potential Key to Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12040955. [PMID: 35454003 PMCID: PMC9029348 DOI: 10.3390/diagnostics12040955] [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: 03/02/2022] [Revised: 03/30/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023] Open
Abstract
Subdural hemorrhage is a key imaging finding in cases of abusive head trauma and one that many radiologists and radiology trainees become familiar with during their years of training. Although it may prove to be a marker of trauma in a young child or infant that presents without a history of injury, the parenchymal insults in these young patients more often lead to the debilitating and sometimes devastating outcomes observed in this young population. It is important to recognize these patterns of parenchymal injuries and how they may differ from the imaging findings in other cases of traumatic injury in young children. In addition, these parenchymal insults may serve as another significant, distinguishing feature when making the medical diagnosis of abusive head injury while still considering alternative diagnoses, including accidental injury. Therefore, as radiologists, we must strive to look beyond the potential cranial injury or subdural hemorrhage for the sometimes more subtle but significant parenchymal insults in abuse.
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Affiliation(s)
- Marguerite M. Caré
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Radiology and Medical Imaging, University of Cincinnati, Cincinnati, OH 45267, USA
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14
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George CL, Harper NS. Computer Algorithms Support Physician Decisions in Traumatic Head Injury. Pediatrics 2022; 149:183817. [PMID: 34890452 PMCID: PMC9645695 DOI: 10.1542/peds.2021-054009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Caroline L.S. George
- Address correspondence to Caroline L.S. George, MD, Otto Bremer Trust Center for Safe and Healthy Children, University of Minnesota, 2512 S 7th St, Suite R107, Minneapolis, MN 55454. E-mail:
| | - Nancy S. Harper
- Department of Pediatrics, University of Minnesota, University of Minnesota Masonic Children’s Hospital, Minneapolis
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15
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Sarkar R, Bassed R, Dipnall JF, Ozanne-Smith J. Orofacial injuries in child family homicide: a population study. Forensic Sci Med Pathol 2021; 17:553-564. [PMID: 34748195 DOI: 10.1007/s12024-021-00402-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
Child family violence homicide (FVH) is a significant public health problem in Australia and globally. Population-wide studies of orofacial injuries in child FVH are uncommon despite their recognized importance. This whole population descriptive study of orofacial injuries in child FVH in Victoria, Australia aims to implement a novel methodological approach to provide an overview of child FVH and describe frequency and patterns of abusive orofacial injuries. Closed cases of child FVH aged 0-17 years, January 2000-December 2018, were identified from screening all Victorian assault deaths for eligible offender relationships. Significant associations of clinical/demographic characteristics were explored using two-step clustering and the Spearman correlation coefficient. Of 895 closed homicide cases, 358 were FV-related. Of the 53 child FVH, 40 were eligible for injury analysis with 36 of these cases (90%) having orofacial injuries. Among these 36 cases, 72% were aged 0-4 years, males predominated (64%) and the injury mechanism was blunt force for 56%. The discrete orofacial injury frequency was associated with the non-orofacial injury frequency (rho: 0.362, 2-tailed p < 0.03). A three-cluster statistical solution was identified, each represented by an injury mechanism. The largest cluster identified a pattern of blunt force trauma in 0-4 years with drug presence, high average non-orofacial injury numbers and parent-offenders. A novel methodological approach was implemented to comprehensively describe the frequency, nature, patterns and risk indicators of orofacial injuries in child FVH. It explored associations between a wide range of clinical and demographic characteristics, which might have otherwise been missed in summary description. These methods will potentially underpin future comparative studies of intentional-unintentional child injuries and fatal-nonfatal child abuse. The study narrows a significant research gap regarding patterns of inflicted injuries, and demographic and clinical indicators in child FVH potentially informing future systematic classification processes, risk assessment tools and pathways to FV intervention.
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Affiliation(s)
- Reena Sarkar
- Department of Forensic Medicine, Monash University, Victoria, 3006, Australia.
| | - Richard Bassed
- Department of Forensic Medicine, Monash University, Victoria, 3006, Australia
- Victorian Institute of Forensic Medicine, Victoria, 3006, Australia
| | - Joanna F Dipnall
- Pre-Hospital, Emergency and Trauma Research, School of Public Health and Preventive Medicine, Monash University, Victoria, 3004, Australia
- School of Medicine, Deakin University, Victoria, 3216, Australia
| | - Joan Ozanne-Smith
- Department of Forensic Medicine, Monash University, Victoria, 3006, Australia
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16
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Han Y, Modaresnezhad M, Nemati H. An Adaptive Machine Learning System for predicting recurrence of child maltreatment: A routine activity theory perspective. Knowl Based Syst 2021. [DOI: 10.1016/j.knosys.2021.107164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Hunter AA, DiVietro S, Schwab-Reese L, Riffon M. An Epidemiologic Examination of Perpetrators of Fatal Child Maltreatment Using the National Violent Death Reporting System (NVDRS). JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9035-NP9052. [PMID: 31185785 DOI: 10.1177/0886260519851787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Fatal child maltreatment in the United States increased 12.9% from 2013 to 2016. Parents are the predominant perpetrators, underscoring the need to examine risk factors associated with this class of offenders. This study examined the relationship between three primary forms of fatal child maltreatment (neonaticide, infanticide, and filicide) and perpetrator characteristics. Using the National Violent Death Reporting System, we employed a retrospective observational study to examine fatal child maltreatment in decedents aged 10 years and below from 2011 to 2015. Multinomial logistic regression of 1,023 maltreatment-related deaths was used to evaluate perpetrator characteristics. Perpetrators were most often male (58%) and the parent of the child victim (53%). Intimate partners represented 22% of perpetrators. The odds of fatal maltreatment were modified by perpetrator age, sex, and relationship to the victim. Results underscore a need for male-focused interventions and research examining the etiology of violence against children perpetrated by the intimate partner of a parent.
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Affiliation(s)
- Amy A Hunter
- Injury Prevention Center, Connecticut Children's, Hartford, CT USA
- Department of Pediatrics, University of Connecticut, Hartford, CT, USA
- Trinity College, Hartford, CT, USA
| | - Susan DiVietro
- Injury Prevention Center, Connecticut Children's, Hartford, CT USA
- Department of Pediatrics, University of Connecticut, Hartford, CT, USA
- Trinity College, Hartford, CT, USA
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18
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A 26-Year Study of Restraint Fatalities Among Children and Adolescents in the United States: A Failure of Organizational Structures and Processes. CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-021-09646-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Background
Physical and mechanical restraints used in treatment, care, education, and corrections programs for children are high-risk interventions primarily due to their adverse physical, emotional, and fatal consequences.
Objective
This study explores the conditions and circumstances of restraint-related fatalities in the United States by asking (1) Who are the children that died due to physical restraint? and (2) How did they die?
Method
The study employs internet search systems to discover and compile information about restraint-related fatalities of children and youth up to 18 years of age from reputable journalism sources, advocacy groups, activists, and governmental and non-governmental agencies. The child cohort from a published study of restraint fatalities in the United States from 1993 to 2003 is combined with restraint fatalities from 2004 to 2018. This study’s scope has expanded to include restraint deaths in community schools, as well as undiscovered restraint deaths from 1993 to 2003 not in the 2006 study.
Results
Seventy-nine restraint-related fatalities occurred over the 26-year period from across a spectrum of children’s out-of-home child welfare, corrections, mental health and disability services. The research provides a data snapshot and examples of how fatalities unfold and their consequences for staff and agencies. Practice recommendations are offered to increase safety and transparency.
Conclusions
The study postulates that restraint fatalities result from a confluence of medical, psychological, and organizational causes; such as cultures prioritizing control, ignoring risk, using dangerous techniques, as well as agencies that lack structures, processes, procedures, and resources to promote learning and to ensure physical and psychological safety.
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19
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Campbell KA, Wood JN, Lindberg DM, Berger RP. A standardized definition of near-fatal child maltreatment: Results of a multidisciplinary Delphi process. CHILD ABUSE & NEGLECT 2021; 112:104893. [PMID: 33373847 PMCID: PMC7856008 DOI: 10.1016/j.chiabu.2020.104893] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND The 2016 Presidential Commission to Eliminate Child Abuse and Neglect Fatalities identified systematic review of all cases of near-fatal child maltreatment as a necessary step towards prevention of child maltreatment fatalities. A critical barrier to adoption of this recommendation is the lack of a standard definition of "near-fatality" in the context of suspected child maltreatment. OBJECTIVE To develop a consensus definition of near-fatal child maltreatment to be used in practice, policy, and research. PARTICIPANTS AND SETTING A multidisciplinary expert panel of 23 individuals from across the U.S. including child abuse pediatricians, pediatric intensivists, pediatric emergency medicine physicians, child welfare administrators, child welfare researchers, and child injury/fatality researchers. METHODS A modified Delphi process reflecting an iterative process of 3 rounds of surveys of expert opinion, statistical summary of survey response, and feedback of summary statistics. Consensus was defined as 75 % of panelists ranking an element as required (≥80 on a scale of 0-100) to meet a definition of near-fatality (75th% threshold). RESULTS Experts defined near-fatal child maltreatment as life-threatening cardiopulmonary dysfunction directly attributable to suspected abuse or neglect as evidenced by (a) respiratory insufficiency/failure requiring intubation and mechanical ventilation, (b) respiratory insufficiency/failure requiring medications to reverse effects of toxic ingestion, or (c) cardiac arrhythmia with/without cardiopulmonary resuscitation (CPR). CONCLUSIONS A consensus definition of near-fatal child maltreatment should be introduced in child protective services processes and in child fatality/near-fatality reviews to improve our ability to identify, review, and respond to trends in near-fatal child maltreatment at local, regional, and national levels.
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Affiliation(s)
- Kristine A Campbell
- Department of Pediatrics, Division of Child Protection and Family Health, University of Utah, Salt Lake City, Utah 84115, United States; The Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, Utah 84115, United States.
| | - Joanne N Wood
- Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, 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
| | - Daniel M Lindberg
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Emergency Medicine, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, United States
| | - Rachel P Berger
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh Pittsburgh, PA, United States
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20
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Evaluating abusive head trauma in children <5 years old: Risk factors and the importance of the social history. J Pediatr Surg 2021; 56:390-396. [PMID: 33220974 DOI: 10.1016/j.jpedsurg.2020.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Abusive head trauma (AHT) is the leading cause traumatic death in children ≤5 years of age. AHT remains seriously under-surveilled, increasing the risk of subsequent injury and death. This study assesses the clinical and social risks associated with fatal and non-fatal AHT. METHODS A single-institution, retrospective review of suspected AHT patients ≤5 years of age between 2010 and 2016 using a prospective hospital forensic registry data yielded demographic, clinical, family, psycho-social and other follow-up information. Descriptive statistics were used to look for differences between patients with AHT and accidental head trauma. Logistic regression estimated the adjusted odds ratios (AOR) for AHT. A receiver operating characteristic (ROC) curve was created to calculate model sensitivity and specificity. RESULTS Forensic evaluations of 783 children age ≤5 years with head trauma met the inclusion criteria; 25 were fatal with median[IQR] age 23[4.5-39.0] months. Of 758 non-fatal patients, age was 7[3.0-11.0] months; 59.5% male; 435 patients (57.4%) presented with a skull fracture, 403 (53.2%) with intracranial hemorrhage. Ultimately 242 (31.9%) were adjudicated AHT, 335(44.2%) were accidental, 181 (23.9%) were undetermined. Clinical factors increasing the risk of AHT included multiple fractures (Exp(β) = 9.9[p = 0.001]), bruising (Expβ = 5.7[p < 0.001]), subdural blood (Exp(β) = 5.3[p = 0.001]), seizures (Exp(β) = 4.9[p = 0.02]), lethargy/unresponsiveness (Exp(β) = 2.24[p = 0.02]), loss of consciousness (Exp(β) = 4.69[p = 0.001]), and unknown mechanism of injury (Exp(β) = 3.9[p = 0.001]); skull fracture reduced the risk of AHT by half (Exp(β) = 0.5[p = 0.011]). Social risks factors included prior police involvement (Exp(β) = 5.9[p = 0.001]), substance abuse (Exp(β) = 5.7[p = .001]), unknown number of adults in the home (Exp(β) = 4.1[p = 0.001]) and intimate partner violence (Exp(β) = 2.3[p = 0.02]). ROC area under the curve (AUC) = 0.90([95% CI = 0.86-0.93] p = .001) provides 73% sensitivity; 91% specificity. CONCLUSIONS To improve surveillance of AHT, interviews should include and consider social factors including caregiver/household substance abuse, intimate partner violence, prior police involvement and household size. An unknown number of adults in home is associated with an increased risk of AHT. STUDY TYPE/LEVEL OF EVIDENCE Prognostic, Level III.
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21
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Chang YT, Chang HY, Chen LW, Lu TH, Tsai HJ, Chen YW, Chang YC, Feng JY. Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006-2015: a nationwide population-based study. Inj Prev 2020; 27:356-362. [PMID: 32788223 DOI: 10.1136/injuryprev-2020-043805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan. METHODS The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time. RESULTS From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1-2 (1.7/100 000 and 2.1/100 000) and 3-5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1-5 years. CONCLUSIONS This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession's sensitivity and competence for the early identification and diagnosis of PAHT is critical.
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Affiliation(s)
- Yi-Ting Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Yi Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yi-Wen Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chun Chang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Ying Feng
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan .,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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22
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Toma M, Dehesa-Baeza A, Chan-Akaley R, Nguyen PDH, Zwibel H. Cerebrospinal Fluid Interaction with Cerebral Cortex during Pediatric Abusive Head Trauma. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1708495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractAbusive head trauma is the leading cause of fatal brain injuries in children younger than 2 years. It is a preventable and severe form of physical child abuse often linked to the forceful shaking of an infant or toddler. Victims of abusive head trauma can suffer permanent neurological damage, resulting in developmental delay and disability. The long-term effects of abusive head trauma are difficult to diagnose and predict. In this model, we use a high-order finite element method paired with the most comprehensive and current head/brain model and next-generation smoothed particle hydrodynamics. This is one of the first fluid–structure interaction frameworks that uses fluid material properties to represent the cerebrospinal fluid (CSF) while including all major anatomical features of the brain. The interaction of CSF with the brain cortex during abusive head trauma is demonstrated during multiple shaking cycles. A comprehensive and precise model that calculates for the role of CSF in neurological trauma will be useful both in the prevention and treatment of abusive head trauma and the determination of prognosis and patient outcomes.
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Affiliation(s)
- Milan Toma
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury Campus, Northern Boulevard, Old Westbury, New York, United States
- Department of Mechanical Engineering, College of Engineering & Computing Sciences, New York Institute of Technology, Old Westbury Campus, Northern Boulevard, Old Westbury, New York, United States
| | - Alfonso Dehesa-Baeza
- Department of Mechanical Engineering, College of Engineering & Computing Sciences, New York Institute of Technology, Old Westbury Campus, Northern Boulevard, Old Westbury, New York, United States
| | - Rosalyn Chan-Akaley
- Lang Research Center, NewYork-Presbyterian Queens, Flushing, New York, United States
| | - Paul D. H. Nguyen
- Pennsylvania State College of Medicine, Hershey, Pennsylvania, United States
| | - Hallie Zwibel
- Department of Sports Medicine, College of Osteopathic Medicine, New York Institute of Technology, Westbury Campus, Northern Boulevard, Old Westbury, New York, United States
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23
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Kennedy JM, Lazoritz S, Palusci VJ. Risk Factors for Child Maltreatment Fatalities in a National Pediatric Inpatient Database. Hosp Pediatr 2020; 10:230-237. [PMID: 32054640 PMCID: PMC7041552 DOI: 10.1542/hpeds.2019-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Child maltreatment (CM) is recognized as a major public health concern, and an important number of children suffer injuries related to abuse and neglect that result in death. We sought to identify risk factors for CM fatalities among hospitalized children that can provide clinicians with information to recognize at-risk children and reduce further death. METHODS In this study, we included cases from the 2012 Kids' Inpatient Database with diagnosis codes related to CM who were <5 years of age and were not transferred to another facility. Potential demographic and clinical risk factors were identified and compared to child fatality in the hospital by using bivariate and multivariate analyses. To assess how cases coded specifically for maltreatment differed from similar cases that only suggested maltreatment, a reduced-model multivariable logistic regression for fatality was created. RESULTS We found 10 825 children <5 years who had inpatient diagnoses coded in their medical record for CM. Most demographic variables (age, race, and sex) were not significantly associated with fatality, whereas clinical variables (transferring in, drowning, ingestions, and burns) were significantly associated with fatality. There were regional differences on the basis of hospital location as well as significantly more chronic conditions, procedure charges, and longer lengths of stay among children who died. Controlling for significant risk factors, those with diagnoses specific for physical abuse had ∼3 times the odds of dying (odds ratio = 2.797; 95% confidence interval: 1.941-4.031). CONCLUSIONS In this study, although infancy and decreased income were associated with increased risk for fatality, more important factors were the types of injuries the child endured and whether the inpatient clinician had identified specific injuries indicating physical abuse.
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Affiliation(s)
- Juliana M Kennedy
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York; and
| | | | - Vincent J Palusci
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York; and
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24
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Corlis M, Damashek A, Meister K, Richardson H, Bonner B. Sibling Child Protective Services Involvement Following a Child Maltreatment Fatality. CHILD MALTREATMENT 2020; 25:43-50. [PMID: 31266348 DOI: 10.1177/1077559519856435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study examined CPS involvement of children surviving the CMF of a sibling as well as predictors of subsequent CPS reports. METHOD Department of Human Services and Child Death Review Board data about children who died from a CMF during 1993-2003 (n = 416) and their siblings in the state of Oklahoma were used to examine CPS involvement and predictors of subsequent CPS reports for surviving siblings. RESULTS Surviving siblings of a victim of a CMF experienced substantial CPS involvement; 81% of the original victims had siblings who were subsequently reported to CPS (n = 1,840). Original victim and family characteristics that predicted a greater rate of siblings' subsequent reports to CPS included younger original victim age, greater number of children in the original victim's home, and more previous reports of the original victim to CPS. DISCUSSION A large portion of families with a CMF struggle to adequately care for their surviving children. Such families may need additional support after a CMF.
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Affiliation(s)
| | | | | | | | - Barbara Bonner
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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25
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Fingarson AK, Pierce MC, Lorenz DJ, Kaczor K, Bennett B, Berger R, Currie M, Herr S, Hickey S, Magana J, Makoroff K, Williams M, Young A, Zuckerbraun N. Who's Watching the Children? Caregiver Features Associated with Physical Child Abuse versus Accidental Injury. J Pediatr 2019; 212:180-187.e1. [PMID: 31255388 PMCID: PMC6707841 DOI: 10.1016/j.jpeds.2019.05.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare caregiver features and caregiving arrangements of children with physical abuse vs accidental injuries. STUDY DESIGN Data came from a prospective, observational, multicenter study investigating bruising and psychosocial characteristics of children younger than 4 years of age. Using logistic regression, we examined how abuse vs accidental injury and severity of injury were associated with caregiver sex, relation to the child, whether caregiving arrangements were different than usual at the time of injury, and length of the main caregiver's relationship with his/her partner. RESULTS Of 1615 patients, 24% were determined to have been physically abused. Abuse was more likely when a male caregiver was present (OR 3.31, 95% CI 2.38-4.62). When the male was the boyfriend of the mother (or another female caregiver), the odds of abuse were very high (OR 169.2, 95% CI 61.3-614.0). Severe or fatal injuries also were more likely when a male caregiver was present. In contrast, abuse was substantially less likely when a female caregiver was present (OR 0.25, 95% CI 0.17-0.37) with the exception of a female babysitter (OR 3.87, 95% CI 2.15-7.01). Caregiving arrangements that were different than usual and caregiver relationships <1 year were also associated with an increased risk of abuse. CONCLUSIONS We identified caregiver features associated with physical abuse. In clinical practice, questions regarding caregiver features may improve recognition of the abused child. This information may also inform future abuse prevention strategies.
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Affiliation(s)
- Amanda K Fingarson
- Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatric Injury Research Lab (PIRL), Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mary Clyde Pierce
- Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatric Injury Research Lab (PIRL), Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Douglas J Lorenz
- Pediatric Injury Research Lab (PIRL), Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Kim Kaczor
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatric Injury Research Lab (PIRL), Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Berkeley Bennett
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rachel Berger
- Department of Pediatrics, University of Pittsburgh, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Melissa Currie
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Sandy Herr
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Sheila Hickey
- Department of Social Work, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Julia Magana
- Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA; Rady Children's Hospital San Diego, San Diego, CA
| | - Kathi Makoroff
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Marcia Williams
- Public Service Administrator, Illinois Department of Children and Family Services, Division of Child Protection, Chicago, IL
| | - Audrey Young
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Noel Zuckerbraun
- Department of Pediatrics, University of Pittsburgh, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
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Soto Martinez ME, Love JC, Pinto DC, Wiersema JM, Derrick SM, Bachim A, Greeley C, Donaruma‐Kwoh M, Truong VTT, Gao S, Crowder CM. The Infant Injury Database: A Tool for the Study of Injury Patterns in Medicolegal Investigations of Child Abuse. J Forensic Sci 2019; 64:1622-1632. [DOI: 10.1111/1556-4029.14120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jennifer C. Love
- Office of the Chief Medical Examiner401 E Street SW Washington DC20024
| | - Deborrah C. Pinto
- Harris County Institute of Forensic Sciences 1861 Old Spanish Trail Houston TX77054
| | - Jason M. Wiersema
- Harris County Institute of Forensic Sciences 1861 Old Spanish Trail Houston TX77054
| | - Sharon M. Derrick
- Department of Life Sciences Texas A&M University – Corpus Christi 6300 Ocean Drive, Unit 5800 Corpus Christi TX 78412
| | - Angela Bachim
- Department of Pediatrics Baylor College of Medicine 6621 Fannin St Houston TX77030
| | - Christopher Greeley
- Department of Pediatrics Baylor College of Medicine 6621 Fannin St Houston TX77030
| | | | - Van Thi Thanh Truong
- Center for Clinical Research and Evidence‐Based Medicine McGovern Medical School The University of Texas Health Science Center at Houston 6431 Fannin St Houston TX 77030
| | - Si Gao
- Harris County Institute of Forensic Sciences 1861 Old Spanish Trail Houston TX77054
| | - Christian M. Crowder
- Dallas County Medical Examiner Office Southwestern Institute of Forensic Sciences 2355 N Stemmons Fwy Dallas TX75207
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Otterman G, Lahne K, Arkema EV, Lucas S, Janson S, Hellström‐Westas L. Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated. Acta Paediatr 2019. [PMID: 29520820 DOI: 10.1111/apa.14309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes, and this study examined the trends in Sweden. METHODS We analysed individual-level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000 to 2014, and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years. RESULTS Child deaths from all causes were 7914, and 2006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100 000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%). CONCLUSION Childhood deaths showed a sustained decline from 2000 to 2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths.
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Affiliation(s)
- Gabriel Otterman
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Klara Lahne
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Elizabeth V. Arkema
- Clinical Epidemiology Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Steven Lucas
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Staffan Janson
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK, Moreno JA, Dias MS, Christian CW, Nelson MD, Silvera VM, Palasis S, Raissaki M, Rossi A, Offiah AC. Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 2018; 48:1048-1065. [PMID: 29796797 DOI: 10.1007/s00247-018-4149-1] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/22/2018] [Accepted: 04/25/2018] [Indexed: 01/01/2023]
Abstract
Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.
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Affiliation(s)
- Arabinda Kumar Choudhary
- Department of Radiology, Nemours AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sabah Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas L Slovis
- Department of Radiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
| | | | - Gary L Hedlund
- Department of Medical Imaging, Primary Children's Hospital, Intermountain Healthcare, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sandeep K Narang
- Division of Child Abuse Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Mark S Dias
- Departments of Neurosurgery and Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Cindy W Christian
- Department of Pediatrics, Child Abuse and Neglect Prevention, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Marvin D Nelson
- Department of Radiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | - Susan Palasis
- Pediatric Neuroradiology, Children's Healthcare of Atlanta, Scottish Rite Campus, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Raissaki
- Department of Radiology, University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Amaka C Offiah
- Paediatric Musculoskeletal Imaging, Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, Western Bank, University of Sheffield, Sheffield, UK
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Boehnke M, Mirsky D, Stence N, Stanley RM, Lindberg DM. Occult head injury is common in children with concern for physical abuse. Pediatr Radiol 2018; 48:1123-1129. [PMID: 29654352 DOI: 10.1007/s00247-018-4128-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/08/2018] [Accepted: 03/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies evaluating small patient cohorts have found a high, but variable, rate of occult head injury in children <2 years old with concern for physical abuse. The American College of Radiology (ACR) recommends clinicians have a low threshold to obtain neuroimaging in these patients. OBJECTIVES Our aim was to determine the prevalence of occult head injury in a large patient cohort with suspected physical abuse using similar selection criteria from previous studies. Additionally, we evaluated proposed risk factors for associations with occult head injury. MATERIALS AND METHODS This was a retrospective, secondary analysis of data collected by an observational study of 20 U.S. child abuse teams that evaluated children who underwent subspecialty evaluation for concern of abuse. We evaluated children <2 years old and excluded those with abnormal mental status, bulging fontanelle, seizure, respiratory arrest, underlying neurological condition, focal neurological deficit or scalp injury. RESULTS One thousand one hundred forty-three subjects met inclusion criteria and 62.5% (714) underwent neuroimaging with either head computed tomography or magnetic resonance imaging. We found an occult head injury prevalence of 19.7% (141). Subjects with emesis (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), macrocephaly (OR 8.5, 95% CI 3.7-20.2), and loss of consciousness (OR 5.1, 95% CI 1.2-22.9) had higher odds of occult head injury. CONCLUSION Our results show a high prevalence of occult head injury in patients <2 years old with suspected physical abuse. Our data support the ACR recommendation that clinicians should have a low threshold to perform neuroimaging in patients <2 years of age.
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Affiliation(s)
- Mitchell Boehnke
- Department of Diagnostic Radiology, Children's Hospital Colorado, 12631 East 17th Ave., Mail Stop 8200, Aurora, CO, 80045, USA. .,University of Colorado School of Medicine, Aurora, CO, USA.
| | - David Mirsky
- Department of Diagnostic Radiology, Children's Hospital Colorado, 12631 East 17th Ave., Mail Stop 8200, Aurora, CO, 80045, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicholas Stence
- Department of Diagnostic Radiology, Children's Hospital Colorado, 12631 East 17th Ave., Mail Stop 8200, Aurora, CO, 80045, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel M Stanley
- Department of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University School of Medicine, Columbus, OH, USA
| | - Daniel M Lindberg
- University of Colorado School of Medicine, Aurora, CO, USA.,The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, Aurora, CO, USA
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Afifi TO, McTavish J, Turner S, MacMillan HL, Wathen CN. The relationship between child protection contact and mental health outcomes among Canadian adults with a child abuse history. CHILD ABUSE & NEGLECT 2018; 79:22-30. [PMID: 29407853 DOI: 10.1016/j.chiabu.2018.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/12/2018] [Accepted: 01/19/2018] [Indexed: 06/07/2023]
Abstract
Despite being a primary response to child abuse, it is currently unknown whether contact with child protection services (CPS) does more good than harm. The aim of the current study was to examine whether contact with CPS is associated with improved mental health outcomes among adult respondents who reported experiencing child abuse, after adjusting for sociodemographic factors and abuse severity. The data were drawn from the 2012 Canadian Community Health Survey-Mental Health (CCHS-2012), which used a multistage stratified cluster design (household-level response rate = 79.8%). Included in this study were individuals aged 18 years and older living in the 10 Canadian provinces (N = 23,395). Child abuse included physical abuse, sexual abuse, and exposure to intimate partner violence (IPV). Mental health outcomes included lifetime mental disorders, lifetime and past year suicidal ideation, plans, and attempts, and current psychological well-being and functioning and distress. All models were adjusted for sociodemographic factors and severity of child abuse. For the majority of outcomes, there were no statistically significant differences between adults with a child abuse history who had CPS contact compared to those without CPS contact. However, those with CPS contact were more likely to report lifetime suicide attempts. These findings suggest that CPS contact is not associated with improved mental health outcomes. Implications are discussed.
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Affiliation(s)
- Tracie O Afifi
- Department of Community Health Sciences and Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
| | - Jill McTavish
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
| | - Sarah Turner
- Department of Community Health Sciences and Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
| | - Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences and Department of Pediatrics, McMaster University, Hamilton, Canada.
| | - C Nadine Wathen
- Faculty of Information & Media Studies, and Research Scholar, Centre for Research and Education on Violence Against Women and Children, Western University, London, Canada.
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Fleming P, Byard RW. Subdural haemorrhage in infants: abuse or natural causes? The importance of thorough child death review. Acta Paediatr 2018; 107:382-383. [PMID: 29280515 DOI: 10.1111/apa.14185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Peter Fleming
- Centre for Child and Adolescent Health; Population Health Sciences; Bristol Medical School; University of Bristol; Bristol UK
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Yamaoka Y, Morisaki N, Noguchi H, Takahashi H, Tamiya N. Comprehensive Assessment of Risk Factors of Cause-Specific Infant Deaths in Japan. J Epidemiol 2018; 28:307-314. [PMID: 29434084 PMCID: PMC5976875 DOI: 10.2188/jea.je20160188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Public attention is given to infants with socially high risks of child abuse and neglect, while clinical attention is provided to infants with a biologically high risk of diseases. However, few studies have systematically evaluated how biological or social factors cross over and affect cause-specific infant mortality. Methods We linked birth data with death data from the Japanese national vital statistics database for all infants born from 2003–2010. Using multivariate logistic regression, we examined the association between biological and social factors and infant mortality due to medical causes (internal causes), abuse (intentional external causes), and accidents (unintentional external causes). Results Of 8,941,501 births, 23,400 (0.26%) infants died by 1 year of age, with 21,884 (93.5%) due to internal causes, 175 (0.75%) due to intentional external causes, and 1,194 (5.1%) due to unintentional external causes. Infants with high social risk (teenage mothers, non-Japanese mothers, single mothers, unemployed household, four or more children in the household, or birth outside of health care facility) had higher risk of death by intentional, unintentional, and internal causes. Infant born with small for gestational age and preterm had higher risks of deaths by internal and unintentional causes, but not by intentional causes. Conclusions Both biological as well as social factors were associated with infant deaths due to internal and external causes. Interdisciplinary support from both public health and clinical-care professionals is needed for infants with high social or biological risk to prevent disease and injury.
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Affiliation(s)
- Yui Yamaoka
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University
| | - Hideto Takahashi
- Office of Information Management and Statistics, Radiation Medical Science Center for the Fukushima Health Management Survey, Faculty of Medicine, Fukushima Medical University
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
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Isumi A, Fujiwara T. Synergistic Effects of Unintended Pregnancy and Young Motherhood on Shaking and Smothering of Infants among Caregivers in Nagoya City, Japan. Front Public Health 2017; 5:245. [PMID: 29018790 PMCID: PMC5614918 DOI: 10.3389/fpubh.2017.00245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Shaking and smothering in response to infant crying are forms of child abuse that often result in death. Unintended pregnancy and young motherhood are risk factors of such child maltreatment that are often comorbid, few studies have examined their synergistic effect on shaking and smothering of infants. We examined the synergistic effects of unintended pregnancy and young motherhood on shaking and smothering among caregivers of infants in Japan. METHODS In this retrospective cohort study, a questionnaire was administered to caregivers enrolled for a health check for 3- to 4-month-old infants between October 2013 and February 2014 in Nagoya City, Japan. The questionnaire data were linked to those from pregnancy notification forms registered at municipalities and included information on women's age and feelings about their pregnancy (N = 4,159). Data were analyzed using logistic regression analysis in 2016. RESULTS Shaking and smothering of 3- to 4-month-old infants occurred at least once in the past month in 2.0 and 1.5% of cases, respectively. Of all participants, 24.8% reported unintended pregnancy while 7.3% were younger than 25 years old. Infants of young mothers (under 25 years old) with unintended pregnancy were 2.77 [95% confidence interval (CI): 1.15-6.68] and 5.61 (95% CI: 2.40-13.1) times more likely to be shaken and smothered, respectively, than those of older mothers with intended pregnancy. In addition, the odds ratio of young mothers with unintended pregnancy regarding smothering was significantly higher than that of older mothers with unintended pregnancy (odds ratio: 2.12; p = 0.02). CONCLUSION Our findings suggest a synergistic effect of unintended pregnancy and young motherhood on smothering. Infants of young mothers with unintended pregnancy are at greater risk of abuse, especially smothering. Prevention strategies are required for young women with unintended pregnancies.
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Affiliation(s)
- Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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Parrish JW, Schnitzer PG, Lanier P, Shanahan ME, Daniels JL, Marshall SW. Classification of maltreatment-related mortality by Child Death Review teams: How reliable are they? CHILD ABUSE & NEGLECT 2017; 67:362-370. [PMID: 28365427 DOI: 10.1016/j.chiabu.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/29/2016] [Accepted: 03/07/2017] [Indexed: 06/07/2023]
Abstract
Accurate estimation of the incidence of maltreatment-related child mortality depends on reliable child fatality review. We examined the inter-rater reliability of maltreatment designation for two Alaskan Child Death Review (CDR) panels. Two different multidisciplinary CDR panels each reviewed a series of 101 infant and child deaths (ages 0-4 years) in Alaska. Both panels independently reviewed identical medical, autopsy, law enforcement, child welfare, and administrative records for each death utilizing the same maltreatment criteria. Percent agreement for maltreatment was 64.7% with a weighted Kappa of 0.61 (95% CI 0.51, 0.70). Across maltreatment subtypes, agreement was highest for abuse (69.3%) and lowest for negligence (60.4%). Discordance was higher if the mother was unmarried or a smoker, if residence was rural, or if there was a family history of child protective services report(s). Incidence estimates did not depend on which panel's data were used. There is substantial room for improvement in the reliability of CDR panel assessment of maltreatment related mortality. Standardized decision guidance for CDR panels may improve the reliability of their data.
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Affiliation(s)
- Jared W Parrish
- Alaska Division of Public Health, Section of Women's, Children's, and Family Health 3601C St., Suite 358, Anchorage, AK, United States; The University of North Carolina at Chapel Hill, Injury Prevention Research Center, 137 East Franklin St, CB# 7505, Chapel Hill, NC 27599, United States.
| | - Patricia G Schnitzer
- The National Center for the Review & Prevention of Child Deaths, c/o Michigan Public Health Institute, 1115 Massachusetts Ave. NW, Washington DC 20005, United States
| | - Paul Lanier
- The University of North Carolina at Chapel Hill, School of Social Work, 325 Pittsboro St. #3550, Chapel Hill, NC 27516, United States
| | - Meghan E Shanahan
- The University of North Carolina at Chapel Hill, Injury Prevention Research Center, 137 East Franklin St, CB# 7505, Chapel Hill, NC 27599, United States; The University of North Carolina at Chapel Hill, School of Public Health, 2101 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC 27599, United States
| | - Julie L Daniels
- The University of North Carolina at Chapel Hill, School of Public Health, 2101 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC 27599, United States
| | - Stephen W Marshall
- The University of North Carolina at Chapel Hill, Injury Prevention Research Center, 137 East Franklin St, CB# 7505, Chapel Hill, NC 27599, United States; The University of North Carolina at Chapel Hill, School of Public Health, 2101 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC 27599, United States
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Spies EL, Klevens J. Fatal Abusive Head Trauma Among Children Aged <5 Years — United States, 1999–2014. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:505-9. [DOI: 10.15585/mmwr.mm6520a1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Purtle J, Rich LJ, Rich JA, Cooper J, Harris EJ, Corbin TJ. The Youth Nonfatal Violent Injury Review Panel: An Innovative Model to Inform Policy and Systems Change. Public Health Rep 2016; 130:610-5. [PMID: 26556932 DOI: 10.1177/003335491513000610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among young people in the United States, nonfatal violent injuries outnumber fatal violent injuries by 171 to 1. The Child Fatality Review Team (CFRT) is a well-established model for informing injury prevention planning. The CFRT's restricted focus on fatal injuries, however, limits its ability to identify opportunities to prevent violent reinjury and address issues unique to nonfatal violent injuries. We adapted the CFRT model to develop and implement a Youth Nonfatal Violent Injury Review Panel. We convened representatives from 23 agencies (e.g., police, housing, and education) quarterly to share administrative information and confidentially discuss cases of nonfatal violent injury. In this article, we describe the panel model and present preliminary data on participants' perceptions of the process. Although outcomes research is needed to evaluate its impacts, the Youth Nonfatal Violent Injury Review Panel offers an innovative, promising, and replicable model for interagency collaboration to prevent youth violence and its effects.
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Affiliation(s)
- Jonathan Purtle
- Drexel University School of Public Health, Department of Health Management and Policy, Philadelphia, PA
| | - Linda J Rich
- Drexel University College of Medicine, Center for Nonviolence and Social Justice, Philadelphia, PA
| | - John A Rich
- Drexel University School of Public Health, Department of Health Management and Policy, Philadelphia, PA
| | - Jazzmin Cooper
- Drexel University College of Medicine, Center for Nonviolence and Social Justice, Philadelphia, PA
| | - Erica J Harris
- Drexel University College of Medicine, Center for Nonviolence and Social Justice, Philadelphia, PA
| | - Theodore J Corbin
- Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, PA
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Bailhache M, Bénard A, Salmi LR. Simulation of the Impact of Programs for Prevention and Screening of Pediatric Abusive Head Trauma. J Neurotrauma 2016; 33:1397-403. [PMID: 26566679 DOI: 10.1089/neu.2015.4014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary prevention programs of pediatric abusive head trauma (PAHT) exist and early screening is proposed, but negative effects of mislabeling parents as abusers, an important issue, are not well documented. The aim of our study was to simulate the possible impact of programs for the primary prevention and screening of PAHT. We developed Markov models that simulate the life histories of PAHT with no intervention, with primary prevention program only, with screening program, and with both programs in a hypothetical cohort of 800,000 newborns in a high-income country. Screening program would be addressed to all families until children are 2 years old, during repeated consultations. Potential side effects for parents being mislabeled as abusers were supposed to increase the probability of PAHT and decrease participation in screening. Time horizon was 2 years with cycles of 15 days. Outcomes were number of deaths and abused children avoided. Uncertainty was specified with probability distributions. After 2 years, the median number of deaths avoided through primary prevention would vary from 6 (95% confidence interval [CI] 2-11) to 28 (95% CI 6-51) per 100,000 newborns. Screening could prevent up to 6 (95% CI 0-29) or cause up to 66 (95% CI 0-361) deaths per 100,000 children born alive. The impact of both programs was uncertain. Our model confirmed the potential benefits of primary prevention and documented the uncertainty associated with screening of PAHT.
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Affiliation(s)
- Marion Bailhache
- 1 CHU de Bordeaux, Pole de pediatrie, Service d'information medicale , Bordeaux, France .,2 Univ. Bordeaux , ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - Antoine Bénard
- 2 Univ. Bordeaux , ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France .,3 Pole de sante publique, Service d'information medicale , Bordeaux, France .,4 Unité de Soutien Méthodologique à la Recherche Clinique et Épidémiologique , Bordeaux, France
| | - Louis-Rachid Salmi
- 2 Univ. Bordeaux , ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France .,3 Pole de sante publique, Service d'information medicale , Bordeaux, France
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Farhat A, Ghasemi A, Mohammadzadeh A, Sezavar M. Abuse and Neglect of Healthy Newborn by Parents: A Social Problem with a Long History. J Clin Diagn Res 2015; 9:SD03-4. [PMID: 26675006 DOI: 10.7860/jcdr/2015/13843.6823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/23/2015] [Indexed: 11/24/2022]
Abstract
A Two-day-old girl who was found in garbage by police and transferred to hospital. She was irritable and dehydrated; also there were burn injuries around her knees and right cheek. Her weight was 3100 grams and physical examinations were normal. Opium was found in urine. Phenobarbital (4 mg/kg/day intravenous every 12 hours) was started for her irritability. After 20 days, infant was entrusted to a welfare organization with coordination of social support of hospital. The prevention of child abuse and neglect is an urgent public health concern. Home visit by welfare organization has been proposed as a promising approach to prevent health and developmental problems among children. We report this case of an abused and neglected newborn.
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Affiliation(s)
- Ahmadshah Farhat
- Neonatologist, Assistant Professor, Department of Pediatrics, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Ali Ghasemi
- Neonatology Subspecialty Resident, Department of Pediatrics, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Ashraf Mohammadzadeh
- Neonatologist, Professor, Department of Pediatrics, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Majid Sezavar
- Fellowship of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
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Beck H, Mittal S, Madigan D, Burd RS. Reassessing mechanism as a predictor of pediatric injury mortality. J Surg Res 2015; 199:641-6. [PMID: 26197948 PMCID: PMC4636960 DOI: 10.1016/j.jss.2015.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of mechanism of injury as a predictor of injury outcome presents practical challenges because this variable may be missing or inaccurate in many databases. The purpose of this study was to determine the importance of mechanism of injury as a predictor of mortality among injured children. METHODS The records of children (<15-y-old) sustaining a blunt injury were obtained from the National Trauma Data Bank. Models predicting injury mortality were developed using mechanism of injury and injury coding using either abbreviated injury scale post-dot values (low-dimensional injury coding) or injury International Classification of Diseases, Ninth Revision codes and their two-way interactions (high-dimensional injury coding). Model performance with and without inclusion of mechanism of injury was compared for both coding schemes, and the relative importance of mechanism of injury as a variable in each model type was evaluated. RESULTS Among 62,569 records, a mortality rate of 0.9% was observed. Inclusion of mechanism of injury improved model performance when using low-dimensional injury coding but was associated with no improvement when using high-dimensional injury coding. Mechanism of injury contributed to 28% of model variance when using low-dimensional injury coding and <1% when high-dimensional injury coding was used. CONCLUSIONS Although mechanism of injury may be an important predictor of injury mortality among children sustaining blunt trauma, its importance as a predictor of mortality depends on the approach used for injury coding. Mechanism of injury is not an essential predictor of outcome after injury when coding schemes are used that better characterize injuries sustained after blunt pediatric trauma.
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Affiliation(s)
- Haley Beck
- Children’s National Medical Center, Division of Trauma and Burn Surgery, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Sushil Mittal
- Scibler Corporation, 1524 Vista Club Circle, #103, Santa Clara, CA, 95054 Santa Clara, CA 95054, USA
| | - David Madigan
- Department of Statistics, Columbia University, Room 1005 SSW, MC 4690, New York, NY 10027, USA
| | - Randall S. Burd
- Children’s National Medical Center, Division of Trauma and Burn Surgery, 111 Michigan Ave NW, Washington, DC 20010, USA
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Nuño M, Pelissier L, Varshneya K, Adamo MA, Drazin D. Outcomes and factors associated with infant abusive head trauma in the US. J Neurosurg Pediatr 2015; 16:515-522. [PMID: 26230462 DOI: 10.3171/2015.3.peds14544] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Head trauma is the leading cause of death in abused children, particularly prior to the age of 2 years. An awareness of factors associated with this condition as well as with a higher risk of mortality is important to improve outcomes and prevent the occurrence of these events. The objective of this study was to evaluate outcomes and factors associated with poor outcomes in infants with diagnosed abusive head trauma (AHT). Patient characteristics, socioeconomic factors, and secondary conditions such as retinal bleeding, contusion, and fractures were considered. METHODS Data were obtained from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. From the Kids' Inpatient Database (KID) sample, the authors identified infants no older than 23 months who had been diagnosed with AHT in 2000, 2003, 2006, and 2009. All statistical analyses were conducted in SAS 9.2. Descriptive statistics were provided, and multivariate logistic regression models were applied to evaluate factors associated with mortality and nonroutine discharge. RESULTS A total of 5195 infants were analyzed in this study. Most infants (85.5%) had ages ranging between 0 and 11 months and were male (61.6%). Overall mortality was 10.8%, with a rate of 9.8% in the 0- to 11-month-old cohort and 16.5% in the 12- to 23-month-olds (p = 0.0003). The overall nonroutine discharge rate of 25.6% increased significantly from 23.3% to 39.0% with increasing age (0-11 vs 12-23 months of age, p < 0.0001). Assuming a multivariate model that adjusted for multiple confounders, the authors found that older infants (12-23 vs 0-11 months, OR 1.81, 95% CI 1.18-2.77) with a secondary diagnosis of retinal bleeding (OR 2.85, 95% CI 2.02-4.00) or shaken baby syndrome (OR 2.09, 95% CI 1.48-2.94) had an increased risk of mortality; these factors were similarly associated with an increased odds of a nonroutine discharge. A higher income ($30,001-$35,000 vs $1-$24,999) was associated with a reduction in the odds of mortality (OR 0.46, 95% CI 0.29-0.72). In the subset of cases (1695 [32.6%]) that specified the perpetrator involved in infant injury, the authors found that the father, stepfather, or boyfriend was most frequently reported (67.4%). A trend for a higher AHT incidence was documented in the early ages (peak at 2 months) compared with older ages. CONCLUSIONS Despite the higher incidence of AHT among infants during the earlier months of life, higher mortality was documented in the 12- to 23-month-olds. Retinal bleeding and shaken baby syndrome were secondary diagnoses associated with higher mortality and nonroutine discharge. Males (67.4%) were overwhelmingly documented as the perpetrators involved in the injury of these infants.
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Affiliation(s)
- Miriam Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Lindsey Pelissier
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Kunal Varshneya
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical Center Hospital, Albany, New York
| | - Doniel Drazin
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and
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King AJ, Farst KJ, Jaeger MW, Onukwube JI, Robbins JM. Maltreatment-Related Emergency Department Visits Among Children 0 to 3 Years Old in the United States. CHILD MALTREATMENT 2015; 20:151-161. [PMID: 25631298 PMCID: PMC9254131 DOI: 10.1177/1077559514567176] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The emergency department (ED) is a vital entry point in the health care system for children who experience maltreatment. This study fills a gap in the maltreatment literature by presenting systematic, national estimates of maltreatment-related ED visits in the United States by children ≤3 years old, from 2006 to 2011, using the Nationwide Emergency Department Sample (NEDS). Children who experienced and likely experienced maltreatment were identified via International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Maltreatment was classified as physical or sexual abuse, neglect, or poly-victimization. The clinical and demographic profiles of children who experienced maltreatment were described. Approximately 10,095 children who experienced maltreatment (0.1% of total ED visits) and 129,807 children who likely experienced maltreatment (1.2% of total ED visits) were documented each year. Maltreatment was associated with significantly greater risk of injury, hospitalization, and death in the ED setting. Physical abuse was the most common explicit maltreatment diagnosis (33 ED visits per 100,000 children ≤3 years old) and neglect was the most common likely maltreatment diagnosis (436 ED visits per 100,000 children ≤3 years old). This study established the NEDS as a valuable complement to existing surveillance efforts of child maltreatment from a public health perspective.
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Affiliation(s)
- Andrew J King
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karen J Farst
- Center for Children at Risk, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Matthew W Jaeger
- Pediatric Emergency Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer I Onukwube
- Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James M Robbins
- Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Lum JAG, Powell M, Timms L, Snow P. A Meta-Analysis of Cross Sectional Studies Investigating Language in Maltreated Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:961-976. [PMID: 25813355 DOI: 10.1044/2015_jslhr-l-14-0056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/12/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE In this review article, meta-analysis was used to summarize research investigating language skills in maltreated children. METHOD A systematic search of published studies was undertaken. Studies were included in the meta-analysis if they investigated language skills in groups comprising maltreated and nonmaltreated children. Studies were selected if these 2 groups of children were of comparable age and from a similar socioeconomic background. RESULTS A total of 26 studies were identified that met the inclusion criteria. Results from the meta-analysis showed that maltreated children demonstrated consistently poorer language skills with respect to receptive vocabulary (k = 19; standardized mean difference [SMD] = .463; 95% confidence interval [CI; .293, .634]; p < .001), expressive language (k = 4; SMD =.860; 95% CI [.557, 1.163]; p < .001), and receptive language (k = 9; SMD =.528; 95% CI [.220, .837]; p < .001). CONCLUSION Together, these results indicate a reliable association between child maltreatment and poor language skills.
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Ibrahim M, Mu'azu AL, Idris N, Rabiu MU, Jibir BW, Getso KI, Mohammad MA, Owolabi FL. Menace of childhood non-accidental traumatic brain injuries: A single unit report. Afr J Paediatr Surg 2015; 12:23-8. [PMID: 25659545 PMCID: PMC4955487 DOI: 10.4103/0189-6725.150943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Childhood traumatic brain injury (TBI) has high rate of mortality and morbidity worldwide. There are dearths of reports from developing countries with large paediatric population on trauma; neurosurgery trauma of nonaccidental origin is not an exemption. This study analysed menace of non-accidental TBI in the paediatric population from our center. MATERIALS AND METHODS This is a single unit, retrospective study of the epidemiology of non-accidental TBI in children starting from September, 2008 to March, 2014. The management outcomes of the epidemiology of the non-accidental TBI were analysed. RESULTS Total of 109 children age range from 0 (intra-natal) to 16 years with a mean of 5.8 ± 4.6 years (median, 5 years) were enrolled into the study. 34 (31.2%) were domestic violence, 26 (23.9%) street assaults, 16 (14.7%) were due to animal assaults and mishaps, 17 (15.6%) fall from heights. Seven (6.4%) cases of collapsed buildings were also seen during the period. Four (3.7%) industrial accidents and two (1.8%) were self-inflicted injuries. There were also three (2.8%) cases of iatrogenic TBI out of which two infants (1.8%) sustained TBI from cesarean section procedure while one patient (0.9%) under general anaesthesia felt from the operation bed resulting to severe TBI. CONCLUSION Child abuse, unprotected child labour, parental/care-givers negligence are the main cause of nonaccidental TBI. Human right activists and government agents should be incorporated in curtailing the menace.
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Affiliation(s)
- Musa Ibrahim
- Department of Surgery, Murtala Mohammad Specialist Hospital, Kano, Nigeria
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A brief history of fatal child maltreatment and neglect. Forensic Sci Med Pathol 2014; 10:413-22. [PMID: 24464796 DOI: 10.1007/s12024-014-9531-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
Child abuse encompasses four major forms of abuse: physical abuse, sexual abuse, psychological abuse, and neglect. The United States retains one of the worst records of child abuse in the industrialized world. It has also been determined that a large portion of these cases are missed and go undocumented in state and federal reporting agencies. In addition, disparate risk factors have been identified for physical abuse and neglect cases, but substance abuse has been found to be a significant factor in all forms of abuse. Fatal child maltreatment and neglect investigations require a multi-pronged and multidisciplinary approach requiring the coordination and information gathering from various agencies. A major difficulty in determining the accidental or non-accidental nature of these cases is that the account surrounding the events of the death of child is acquired from the caretaker. In this review, we outline common diagnostic characteristics and patterns of non-accidental injuries and neglect as a result of nutritional deprivation.
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