1
|
Gottesman E, Elman A, Rosen T. Elder Mistreatment: Emergency Department Recognition and Management. Clin Geriatr Med 2023; 39:553-573. [PMID: 37798065 DOI: 10.1016/j.cger.2023.05.007] [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] [Indexed: 10/07/2023]
Abstract
Elder mistreatment is experienced by 5% to 15% of community-dwelling older adults each year. An emergency department (ED) encounter offers an important opportunity to identify elder mistreatment and initiate intervention. Strategies to improve detection of elder mistreatment include identifying high-risk patients; recognizing suggestive findings from the history, physical examination, imaging, and laboratory tests; and/or using screening tools. ED management of elder mistreatment includes addressing acute issues, maximizing the patient's safety, and reporting to the authorities when appropriate.
Collapse
Affiliation(s)
- Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, USA.
| |
Collapse
|
2
|
Matoori S, Khurana B, Balcom MC, Froehlich JM, Janssen S, Forstner R, King AD, Koh DM, Gutzeit A. Addressing intimate partner violence during the COVID-19 pandemic and beyond: how radiologists can make a difference. Eur Radiol 2021; 31:2126-2131. [PMID: 33021703 PMCID: PMC7537584 DOI: 10.1007/s00330-020-07332-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023]
Abstract
Faced with the COVID-19 pandemic, many countries both in Europe and across the world implemented strict stay-at-home orders. These measures helped to slow the spread of the coronavirus but also led to increased mental and physical health issues for the domestically confined population, including an increase in the occurrence of intimate partner violence (IPV) in many countries. IPV is defined as behavior that inflicts physical, psychological, or sexual harm within an intimate relationship. We believe that as radiologists, we can make a difference by being cognizant of this condition, raising an alert when appropriate and treating suspected victims with care and empathy. The aim of this Special Report is to raise awareness of IPV among radiologists and to suggest strategies by which to identify and support IPV victims. KEY POINTS: • The COVID-19 pandemic led to a marked increase in the number of intimate partner violence (IPV) cases, potentially leading to increased emergency department visits and radiological examinations. • Most IPV-related fractures affect the face, fingers, and upper trunk, and may easily be misinterpreted as routine trauma. • Radiologists should carefully review the medical history of suspicious cases, discuss the suspicion with the referring physician, and proactively engage in a private conversation with the patient, pointing to actionable resources for IPV victims.
Collapse
Affiliation(s)
- Simon Matoori
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
- Institute of Radiology and Nuclear Medicine and Cancer Center St. Anna Klinik Luzern, Hirslanden Klinik St. Anna, Lucerne, Switzerland.
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria.
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marta Chadwick Balcom
- Community Health Intervention and Prevention Programs, Brigham and Women's Hospital, Boston, MA, USA
| | - Johannes M Froehlich
- Institute of Radiology and Nuclear Medicine and Cancer Center St. Anna Klinik Luzern, Hirslanden Klinik St. Anna, Lucerne, Switzerland
- Clinical Research Group, Klus Apotheke Zurich, Zurich, Switzerland
| | - Sonja Janssen
- Clinic of Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rosemarie Forstner
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Andreas Gutzeit
- Institute of Radiology and Nuclear Medicine and Cancer Center St. Anna Klinik Luzern, Hirslanden Klinik St. Anna, Lucerne, Switzerland.
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria.
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland.
| |
Collapse
|
3
|
Intimate partner violence crisis in the COVID-19 pandemic: how can radiologists make a difference? Eur Radiol 2020; 30:6933-6936. [PMID: 32607631 PMCID: PMC7326304 DOI: 10.1007/s00330-020-07043-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022]
Abstract
• The COVID-19 crisis resulted in a variety of physical and mental health issues beyond the viral infection itself, as indicated by an increase in domestic violence. • Radiologists should be aware of typical intimate partner violence (IPV) injury patterns, actively ask potential IPV victims about the cause of injury, and be familiar with support systems for IPV victims of their institutions. • Emergency and radiology departments should review their protocols for identifying and supporting IPV victims, and train their staff to work together to implement these measures during and beyond the COVID-19 crisis.
Collapse
|
4
|
Rosen T, Stern ME, Elman A, Mulcare MR. Identifying and Initiating Intervention for Elder Abuse and Neglect in the Emergency Department. Clin Geriatr Med 2018; 34:435-451. [PMID: 30031426 PMCID: PMC6057151 DOI: 10.1016/j.cger.2018.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Elder abuse and neglect are common and may have serious medical and social consequences but are infrequently identified. An emergency department (ED) visit represents a unique but usually missed opportunity to identify potential abuse and initiate intervention. ED assessment should include observation of patient-caregiver interaction, comprehensive medical history, and head-to-toe physical examination. Formal screening protocols may also be useful. ED providers concerned about elder abuse or neglect should document their findings in detail. ED interventions for suspected or confirmed elder abuse or neglect include treatment of acute medical, traumatic, and psychological issues; ensuring patient safety; and reporting to the authorities.
Collapse
Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA.
| | - Michael E Stern
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
| | - Alyssa Elman
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
| | - Mary R Mulcare
- Division of Emergency Medicine, Emergency Department, Weill Cornell Medical College, NewYork-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Room M130, New York, NY 10065, USA
| |
Collapse
|
5
|
Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF. Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach. Ann Emerg Med 2016; 68:378-82. [PMID: 27005448 PMCID: PMC5391043 DOI: 10.1016/j.annemergmed.2016.01.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, NY.
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, NY
| | | |
Collapse
|
6
|
KARIBE H, KAMEYAMA M, HAYASHI T, NARISAWA A, TOMINAGA T. Acute Subdural Hematoma in Infants with Abusive Head Trauma: A Literature Review. Neurol Med Chir (Tokyo) 2016; 56:264-73. [PMID: 26960448 PMCID: PMC4870181 DOI: 10.2176/nmc.ra.2015-0308] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/01/2016] [Indexed: 11/20/2022] Open
Abstract
The number of cases with child abuse is increasing in Japan, and abusive head trauma (AHT) is a major cause of death in abused children. Child abuse has been recognized by the late 19th century, and widely accepted as battered child syndrome in the middle of the 20th century. As terms, there had been considerable mechanistic controversies between shaken-baby and -impact syndrome until the beginning of the 21st century. In recent years, AHT has been utilized as a less mechanistic term. Most of the characteristics of AHT in Japan have been similar to those in the United States as follows: infant is the most common victim, acute subdural hematoma (SDH) is the most common intracranial lesion, and retinal hemorrhage is often complicated. On the other hand, several characteristics have been different as follows: mother is the most common perpetrators, impact is a more common mechanism of trauma than shaking, and external trauma is more common reflecting the existence of impact. Since AHT as well as child abuse is a social pathological phenomenon influenced by victims, perpetrators, socioeconomic circumstances, and so on, various aspects of AHT as well as child abuse can be changed with times. Actually, a recent paper suggests such changes in infants with acute SDH due to AHT. In this review article, AHT, abusive infantile acute SDH in particular, are reviewed from the aspect of neurosurgical perspectives, including its mechanisms of trauma, biomechanics, clinical features, management, and prognosis, to update the trend in Japan.
Collapse
Affiliation(s)
- Hiroshi KARIBE
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi
| | | | - Toshiaki HAYASHI
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi
| | - Ayumi NARISAWA
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
| |
Collapse
|
7
|
Thornton MD, Della-Giustina K, Aronson PL. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin North Am 2015; 33:423-49. [PMID: 25892730 DOI: 10.1016/j.emc.2014.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Orthopedic injuries in children are unique when compared to those of adults because of the physiologic differences, especially the growth plates, stronger periosteum, and dynamic state of growth. The approach to the orthopedically injured child requires a gentle yet thorough focus with consideration of the growth plates as a primary area of weakness and growth when the child sustains an injury. Understanding the developmental stages of bones is paramount to being able to manage any injuries. Finally, what appears to be a benign injury may portend more serious issues, because nonaccidental trauma must always be considered in the evaluation of the injured child.
Collapse
Affiliation(s)
- Matthew D Thornton
- Department of Emergency Medicine, Bay State Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Karen Della-Giustina
- Department of Emergency Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA.
| | - Paul L Aronson
- Department of Pediatric Emergency Medicine, Yale New Haven Childrens Hospital, 100 York Street, Suite 1F, New Haven, CT 06511, USA
| |
Collapse
|
8
|
Phillips KL, Bastin ST, Davies-Payne D, Browne D, Bird HL, Craw S, Duncan D, Depree P, Leigh A, McLaughlin A, Metcalfe R, Murdoch J, Pearce K, Perry D, Thomas I, Thomson GD, Vogel S, Wilson F, Teele RL. Radiographic skeletal survey for non-accidental injury: Systematic review and development of a national New Zealand protocol. J Med Imaging Radiat Oncol 2015; 59:54-65. [DOI: 10.1111/1754-9485.12271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/20/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Karin L. Phillips
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Sonja T. Bastin
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - David Davies-Payne
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Diana Browne
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Helen L. Bird
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Susan Craw
- Department of Radiology; Dunedin Hospital; Dunedin New Zealand
| | - David Duncan
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Philippa Depree
- Department of Radiology; Christchurch Hospital; Christchurch New Zealand
| | - Alina Leigh
- Fulford Radiology; Taranaki Base Hospital; New Plymouth New Zealand
| | - Andrew McLaughlin
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
- Department of Radiology; Middlemore Hospital; Auckland New Zealand
| | - Russell Metcalfe
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Jean Murdoch
- Department of Radiology; Capital and Coast District Health Board; Wellington New Zealand
| | - Kirsten Pearce
- Department of Radiology; Waitemata District Health Board; Auckland New Zealand
| | - David Perry
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Iona Thomas
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Glen D. Thomson
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Sally Vogel
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Francessa Wilson
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Rita L. Teele
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
- University of Auckland School of Medicine; Auckland New Zealand
| |
Collapse
|
9
|
Tuncer N, Yayci N, Ekinci G, Inanici MA, Elmaci I. Intracranial sewing needle in a man with seizure: a case of child abuse? Forensic Sci Int 2006; 168:212-4. [PMID: 16567074 DOI: 10.1016/j.forsciint.2006.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 01/24/2006] [Accepted: 02/04/2006] [Indexed: 11/23/2022]
Abstract
Physical abuse in infancy can cause persistent neurological deficits. Although intracranial foreign bodies are generally secondary to penetrating trauma or surgical procedures, rarely they also occur as a result of child abuse. A 32-year-old man presented with the complaint of generalized tonic clonic seizures to the Neurology Department of Marmara, University Hospital. Computerized tomography (CT) scan revealed a sewing needle located within the temporal lobe. The location and the position of the needle suggested that it must have been introduced in infancy through the lamdoid suture before the closure of it, as an unsuccessful deliberate homicide attempt or accidental injury.
Collapse
Affiliation(s)
- Neşe Tuncer
- Marmara University, School of Medicine, Department of Neurology, 36. Ada Ata 2-5 Daire:110 Ataşehir, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
10
|
|
11
|
|
12
|
Barsness KA, Cha ES, Bensard DD, Calkins CM, Partrick DA, Karrer FM, Strain JD. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. THE JOURNAL OF TRAUMA 2003; 54:1107-10. [PMID: 12813330 DOI: 10.1097/01.ta.0000068992.01030.a8] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rib fractures have a strong association with nonaccidental trauma (NAT) and severe trauma. The purposes of this study were to evaluate rib fractures in children to determine (1) the positive predictive value of a rib fracture in defining NAT and (2) the frequency of rib fractures as the only skeletal manifestation of NAT. METHODS We reviewed the medical records and imaging of all children with rib fractures over a 6-year period. NAT was determined by the Child Advocacy and Protection team. RESULTS In children younger than 3 years of age, the positive predictive value (PPV) of a rib fracture as an indicator of NAT was 95%. The positive predictive value increased to 100% once historical and clinical circumstance excluded all other causes for rib fractures. CONCLUSION In this study, rib fracture(s) were the only skeletal manifestation of NAT in 29% of the children.
Collapse
Affiliation(s)
- Katherine A Barsness
- Department of Surgery, The Children's Hospital, University of Colorado Health Sciences Center, Denver, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
Virtopsy, a New Imaging Horizon in Forensic Pathology: Virtual Autopsy by Postmortem Multislice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI)—a Feasibility Study. J Forensic Sci 2003. [DOI: 10.1520/jfs2002166] [Citation(s) in RCA: 411] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
14
|
Abstract
OBJECTIVE Previous studies of child abuse have used the presenting history as part of the case definition of abuse. Thus, data from these studies cannot be used to determine the diagnostic utility of historical features for identifying cases of abuse. The objective of this study was to determine the diagnostic utility of certain historical features for identifying cases of abusive head trauma. METHODS We retrospectively studied all children, aged 0 to 3 years, who had acute traumatic intracranial injury and were admitted to a tertiary care pediatric hospital from 1993 to 2000. Cases were categorized as either "definite abuse" or "not definite abuse" on the basis of radiologic, ophthalmologic, and physical examination findings, without regard to the presenting history. RESULTS Forty-nine (30%) of 163 children met the criteria for definite abuse. Having no history of trauma had a high specificity (0.97) and positive predictive value (PPV; 0.92) for abuse. Among the subgroup of patients with persistent neurologic abnormality at hospital discharge (n = 34), having a history of no or low-impact trauma had a specificity of 1.0 and a PPV of 1.0 for definite abuse. Injuries were blamed on home resuscitative efforts in 12% of definite abuse cases and 0% of not definite abuse cases. The initial history of trauma was changed in 9% of definite abuse cases, as compared with 0% of not definite abuse cases. CONCLUSION Among young children with a head injury, certain historical features have high specificity and PPV for diagnosing child abuse.
Collapse
Affiliation(s)
- Joeli Hettler
- Division of Emergency Medicine, Children's Hospital, Boston, Harvard Medical School, Boston, MA 02115, USA.
| | | |
Collapse
|
15
|
Affiliation(s)
- Marguerite Caré
- Section of Neuroradiology, Cincinnati Children's Hospital Medical Center, Department of Pediatric Radiology, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| |
Collapse
|
16
|
Alvares BR, Mezzacappa MAM, Poterio CB. Sífilis congênita simulando a síndrome da criança espancada: relato de caso. Radiol Bras 2002. [DOI: 10.1590/s0100-39842002000400015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As autoras descrevem os achados radiológicos dos ossos longos de um recém-nascido com diagnóstico confirmado de sífilis congênita, enfatizando o diagnóstico diferencial com a síndrome da criança espancada. É apresentada a evolução radiológica das lesões nos ossos longos, do nascimento até o quarto mês de vida. Os dados clínicos e laboratoriais do recém-nascido, as radiografias anteriores e os achados radiológicos característicos da doença de base foram essenciais para o diagnóstico desta doença.
Collapse
|
17
|
Abstract
Skeletal imaging plays a critical role in the diagnosis of abuse. High-detail radiographs of the entire skeleton, at times supplemented with nuclear imaging, CT, US, and MR imaging, elucidate the variety of findings with this entity. The radiologist's role includes careful analysis of clinical history, familiarity with typical osseous findings in abuse, and awareness of potential normal variants and pitfalls. An accurate diagnosis of abuse can then lead to appropriate measures to protect all family members at risk of serious injury.
Collapse
Affiliation(s)
- K Nimkin
- Department of Radiology, UMass Memorial Health Care, Worcester, Massachusetts 01655, USA.
| | | |
Collapse
|
18
|
|
19
|
Della-Giustina K, Della-Giustina DA. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin North Am 1999; 17:895-922, vii. [PMID: 10584108 DOI: 10.1016/s0733-8627(05)70103-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Orthopedic injuries in children are unique in terms of the mechanisms of injury, pathophysiology, and healing. This article reviews the pediatric fracture patterns and common pediatric injuries or complaints seen in the emergency department, with an emphasis on management in the emergency department. Additionally, the approach to pediatric cervical spine injuries and child abuse will be described as it pertains to the emergency physician.
Collapse
Affiliation(s)
- K Della-Giustina
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington, USA
| | | |
Collapse
|
20
|
Abstract
Child abuse has been documented in various forms since the beginning of recorded history. This article reviews the legal aspects of reporting child abuse, the epidemiology of child abuse, various physical manifestations of child abuse, and effective treatment procedures. It is only with the appropriate interventions that physicians can begin to make an impact on the future of abused children.
Collapse
Affiliation(s)
- A M Jain
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
| |
Collapse
|
21
|
Chabrol B, Decarie JC, Fortin G. The role of cranial MRI in identifying patients suffering from child abuse and presenting with unexplained neurological findings. CHILD ABUSE & NEGLECT 1999; 23:217-228. [PMID: 10219941 DOI: 10.1016/s0145-2134(98)00128-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The aim of this study was to demonstrate the usefulness of cerebral MRI to detect possible child abuse in children with unexplained neurologic findings. METHOD Between 1990 and 1997, 208 children were referred for suspected physical child abuse to the Child Protection Clinic of Ste-Justine Hospital, a tertiary care pediatric hospital. Among them, 39 children presented initially with neurological findings. For 27 of them, the CT Scan results prompted the diagnosis of child abuse. However, in 12 children, even if a CT-Scan was performed, the diagnosis and/or the mechanisms of the neurologic distress remained obscure. Investigation was completed with MRI study in those 12 cases. RESULTS MRI findings were diagnostic for physical abuse in eight cases. A diagnosis of child abuse was made in two more cases by a combination of MRI and skeletal survey findings. In one case, MRI was suggestive but the diagnosis of child abuse could not be confirmed. One case was misinterpreted as normal. CONCLUSIONS MRI is the test of choice to rule out child abuse when faced with a child presenting unexplained neurologic signs lasting for few days. The fact that MRI can better differentiate collections of different ages makes this imaging test particularly useful in identifying cases of child abuse. These results, however, always have to be integrated in a well conducted multidisciplinary clinical approach.
Collapse
Affiliation(s)
- B Chabrol
- Neuropediatrics Unit, CHU Timone, Marseille, France
| | | | | |
Collapse
|
22
|
Altemeier WA, Levine C, Rodriguez F. A pediatrician's view. Imaging procedures in pediatric neurological conditions. Pediatr Ann 1998; 27:607-9. [PMID: 9798240 DOI: 10.3928/0090-4481-19981001-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|