Knowing the signs and types of injuries associated with child abuse is key to preventing additional harm or fatalities among abused children, according to a report published in the November issue of Pediatrics.
Researchers looked at 30,355 children with putative sentinel injuries, measuring rates of abuse diagnosis and rates of testing used to identify certain injuries, the report said. Information for the report was obtained through the Pediatric Health Information System database and included patients seen in the emergency department, observation and/or inpatient setting between January 2004 and December 2011. Abuse is commonly diagnosed among children who have sentinel injuries, including the majority of children less than 24 months old with rib fractures, the report stated. Intracranial hemorrhage and abdominal injuries also were associated with more than 20% of cases, according to the report.
Burns and isolated skull fractures showed the lowest rates of abuse diagnoses, though rates were still high when compared the baseline risk for children without putative sentinel injuries, the report said. Researchers noted that although bruises were not that unusual in older children, they can be cause for concern among children 6 months old and younger.
“Several putative sentinel injuries are associated with high rates of physical abuse,” researchers concluded. “Future work is warranted to test whether routine testing for abuse in these children can improve early recognition of abuse.”
Among patient visits logged in the PHIS database during the study period, 7,062 were linked to a diagnosis of abuse, according to the report. Abuse diagnosis rates for children less than 24 months old for each of the 18 participating US hospitals in the PHIS database ranged from 0.04% to 0.46%. Researchers found 34,565 putative sentinel injuries were discovered during 30,766 visits among 30,355 children less than 24 months old. A majority of the children — 89.8% — had only one putative sentinel injury found, with two such injuries being found in 7.6% of patients and three to six injuries among 2.6% of patients.
The study also showed that testing varied widely between facilities for all injuries and testing methods, with the rate of skeletal surveys among infants with skull fractures ranging from a little more than 20% of patients to 74% of patients, the report said.
Radiographic skeletal surveys are recommended as mandatory for children who are suspected of being abused. The American College of Radiology also recommends this practice. The report’s authors pointed out that whether abuse risk is immediate, near or long-term, the presence of a sentinel injury should encourage healthcare providers to consider the possibility of abuse and test for more suspicious injuries.
“Previous work has revealed that physical abuse is commonly missed,” the authors write. “Our data reveal an overall high rate of diagnosed abuse, but tremendous variability in evaluation and diagnosis of abuse across hospitals and injury categories. Together, these facts suggest that increased, routine, or [protocoled] testing for children with these injuries can identify other children with abuse that might otherwise be missed.”
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