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Suspected Physical Child Maltreatment

BROWSE EVIDENCE REPOSITORY

 

Bottom Line Recommendations English (2) French (1) All (3)

Bottom Line Recommendations: Suspected Physical Child Maltreatment

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Boutis, K, Ornstein A, Coombs C & TREKK Network

Bottom line recommendations for the treatment and management of suspected physical child maltreatment. Published online: August 2018.

Bottom Line: NICE Guidance: Child maltreatment: when to suspect maltreatment in under 16s

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National Institute for Health and Care Excellence

This guideline covers the signs of possible child maltreatment in children and young people aged under 18 years. It aims to raise awareness and help health professionals who are not child protection specialists to identify the features of physical, sexual and emotional abuse, neglect and fabricated or induced illness.

Recommandations de Base: Suspicion de maltraitance physique d’un enfant

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Boutis, K, Ornstein A, Coombs C & TREKK Network

Bottom line recommendations for the treatment and management of suspected physical child maltreatment - FRENCH. Published online: October 2018.

Bottom Line Recommendations: Suspected Physical Child Maltreatment

Download

Boutis, K, Ornstein A, Coombs C & TREKK Network

Bottom line recommendations for the treatment and management of suspected physical child maltreatment. Published online: August 2018.

Recommandations de Base: Suspicion de maltraitance physique d’un enfant

Download

Boutis, K, Ornstein A, Coombs C & TREKK Network

Bottom line recommendations for the treatment and management of suspected physical child maltreatment - FRENCH. Published online: October 2018.

Bottom Line: NICE Guidance: Child maltreatment: when to suspect maltreatment in under 16s

Visit

National Institute for Health and Care Excellence

This guideline covers the signs of possible child maltreatment in children and young people aged under 18 years. It aims to raise awareness and help health professionals who are not child protection specialists to identify the features of physical, sexual and emotional abuse, neglect and fabricated or induced illness.

Clinical guidelines English (5) French All (5)

Clinical Guideline: The Evaluation of Suspected Child Physical Abuse

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Christian CW, Committee on Child Abuse and Neglect, American Academy of Pedia...

Childphysicalabuseis an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and preventchild abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physicalabuseof children.

Clinical Practice Guideline: The medical assessment of bruising in suspected child maltreatment cases: A clinical perspective

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Ward MG, Ornstein A, Niec A, Murray CL, Canadian Paediatric Society Child and...

This practice point will help clinicians to distinguish between accidental and inflicted bruises, to evaluate and manage bruising in the context of suspected child maltreatment, and to evaluate for an underlying medical predisposition to bruising.

Clinical Guideline: Evaluation for bleeding disorders in suspected child abuse

Visit

Anderst JD, Carpenter SL, Abshire TC, Section on Hematology/Oncology and Comm...

This clinical report provides guidance to pediatricians and other clinicians regarding the evaluation for bleeding disorders whenchild abuseis suspected.

Clinical Guideline: ACR Appropriateness Criteria: Suspected Physical Abuse - Child

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American College of Radiology

Initial imaging appropriateness criteria for suspected physical abuse in children.

Clinical Guideline: Orthopaedic Aspects of Child Abuse

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Mininder S, Kocher MS

Fractures are the second most common presentation of physical abuse after skin lesions, and approximately one third of abused children are eventually seen by an orthopaedic surgeon. Thus, an understanding of the differences in the general and musculoskeletal manifestations of accidental and nonaccidental injury is essential for recognition and appropriate management of the abused child.

Clinical Guideline: The Evaluation of Suspected Child Physical Abuse

Visit

Christian CW, Committee on Child Abuse and Neglect, American Academy of Pedia...

Childphysicalabuseis an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and preventchild abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physicalabuseof children.

Clinical Practice Guideline: The medical assessment of bruising in suspected child maltreatment cases: A clinical perspective

Visit

Ward MG, Ornstein A, Niec A, Murray CL, Canadian Paediatric Society Child and...

This practice point will help clinicians to distinguish between accidental and inflicted bruises, to evaluate and manage bruising in the context of suspected child maltreatment, and to evaluate for an underlying medical predisposition to bruising.

Clinical Guideline: Evaluation for bleeding disorders in suspected child abuse

Visit

Anderst JD, Carpenter SL, Abshire TC, Section on Hematology/Oncology and Comm...

This clinical report provides guidance to pediatricians and other clinicians regarding the evaluation for bleeding disorders whenchild abuseis suspected.

Clinical Guideline: ACR Appropriateness Criteria: Suspected Physical Abuse - Child

Visit

American College of Radiology

Initial imaging appropriateness criteria for suspected physical abuse in children.

Clinical Guideline: Orthopaedic Aspects of Child Abuse

Visit

Mininder S, Kocher MS

Fractures are the second most common presentation of physical abuse after skin lesions, and approximately one third of abused children are eventually seen by an orthopaedic surgeon. Thus, an understanding of the differences in the general and musculoskeletal manifestations of accidental and nonaccidental injury is essential for recognition and appropriate management of the abused child.

Overviews of systematic reviews English (2) French All (2)

Overview of Systematic Reviews: Systematic reviews of bruising in relation to child abuse-what have we learnt: an overview of review updates

Visit

Maguire S, Mann M

This overview examined systematic review evidence to answer the questions: can you age bruises accurately in children, and are there patterns of bruising in childhood which are either diagnostic or suggestive of abuse?

Overview of Systematic Reviews: What does the recent literature add to the identification and investigation of fractures in child abuse: an overview of review updates 2005-2013

Visit

Maguire S, Cowley L, Mann M, Kemp A

Objective: To identify additional studies that contribute to the evidence on distinguishing which fractures are indicative of abuse and optimizing the identification of occult fractures.

Overview of Systematic Reviews: Systematic reviews of bruising in relation to child abuse-what have we learnt: an overview of review updates

Visit

Maguire S, Mann M

This overview examined systematic review evidence to answer the questions: can you age bruises accurately in children, and are there patterns of bruising in childhood which are either diagnostic or suggestive of abuse?

Overview of Systematic Reviews: What does the recent literature add to the identification and investigation of fractures in child abuse: an overview of review updates 2005-2013

Visit

Maguire S, Cowley L, Mann M, Kemp A

Objective: To identify additional studies that contribute to the evidence on distinguishing which fractures are indicative of abuse and optimizing the identification of occult fractures.

Systematic reviews English (14) French All (14)

Systematic Review: Contact, Cigarette and Flame Burns in Physical Abuse: A Systematic Review

Visit

Kemp AM, Maguire SA, Lumb RC, Harris SM, Mann MK

This systematic review identifies features of intentional non-scald burns in physical abuse.

Systematic Review: A systematic review of abusive visceral injuries in childhood--their range and recognition

Visit

Maguire SA, Upadhyaya M, Evans A, Mann MK, Haroon MM, Tempest V, Lumb RC, Kem...

Objectives: To define what abusive visceral injuries occur, including their clinical features and the value of screening tests for abdominal injury among abused children.

Systematic Review: Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

Visit

Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, Mann MK, Temp...

Aim: To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT).

Systematic Review: Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review

Visit

Piteau SJ, Ward MG, Barrowman NJ, Plint AC

Objective: To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children.

Systematic Review: Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma?

Visit

Kemp AM, Jaspan T, Griffiths J, Stoodley N, Mann MK, Tempest V, Maguire SA

Objective: To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT).

Systematic Review: Unexplainedfractures:child abuseorbone disease? A systematic review

Visit

Pandya NK, Baldwin K, Kamath AF, Wenger DR, Hosalkar HS

Child abuse and neglect (CAN) is a serious problem that has major implications for the welfare of the child involved. Unexplained fractures are of particular concern to the orthopaedic surgeon, who must often consider alternative diagnoses to CAN. We therefore (1) determined which bone diseases most commonly mimic CAN; (2) what types of osteogenesis imperfecta (OI) are most commonly confused with CAN and why; and (3) what specific findings in OI and bone disease render a mistaken diagnosis of CAN more likely.

Systematic Review: What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review

Visit

Kemp AM, Joshi AH, Mann M, Tempest V, Liu A, Holden S, Maguire S

Aim: Systematic review of 'What are the clinical and radiological characteristics of inflicted spinal injury?'

Systematic Review: Screening injured children for physical abuse or neglect in emergency departments: a systematic review

Visit

Woodman J, Lecky F, Hodes D, Pitt M, Taylor B, Gilbert R

Screening markers are used in emergency departments (EDs) to identify children who should be assessed for possible physicalabuseand neglect. We conducted three systematic reviews evaluating age, repeat attendance and injury type as markers for physicalabuseor neglect in injured children attending EDs.

Systematic Review: What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review

Visit

Kemp AM, Rajaram S, Mann M, Tempest V, Farewell D, Gawne-Cain ML, Jaspan T, M...

Aim: To investigate the optimal neuroradiological investigation strategy to identify inflicted brain injury (iBI).

Systematic Review: Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review

Visit

Maguire S, Pickerd N, Farewell D, Mann M, Tempest V, Kemp AM

Aim: A systematic review of the scientific literature to define clinical indicators distinguishing inflicted (iBI) from non-inflicted brain injury (niBI).

Systematic Review: A systematic review of the features that indicate intentional scalds in children

Visit

Maguire S, Moynihan S, Mann M, Potokar T, Kemp AM

Aim: To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds.

Systematic Review: Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries

Visit

Maguire S, Hunter B, Hunter L, Sibert JR, Mann M, Kemp AM

A torn labial frenum is widely regarded as pathognomonic of abuse. We systematically reviewed the evidence for this, and to define other intra-oral injuries found in physical abuse.

Systematic Review: Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review

Visit

Maguire S, Mann MK, Sibert J, Kemp A

Aim: To investigate what patterns of bruising are diagnostic or suggestive of child abuse by means of a systematic review.

Systematic Review: Can you age bruises accurately in children? A systematic review

Visit

Maguire S, Mann MK, Sibert J, Kemp A

Aim: To investigate whether it is possible to determine the age of a bruise in a child in clinical practice by means of a systematic review.

Systematic Review: Contact, Cigarette and Flame Burns in Physical Abuse: A Systematic Review

Visit

Kemp AM, Maguire SA, Lumb RC, Harris SM, Mann MK

This systematic review identifies features of intentional non-scald burns in physical abuse.

Systematic Review: A systematic review of abusive visceral injuries in childhood--their range and recognition

Visit

Maguire SA, Upadhyaya M, Evans A, Mann MK, Haroon MM, Tempest V, Lumb RC, Kem...

Objectives: To define what abusive visceral injuries occur, including their clinical features and the value of screening tests for abdominal injury among abused children.

Systematic Review: Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

Visit

Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, Mann MK, Temp...

Aim: To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT).

Systematic Review: Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review

Visit

Piteau SJ, Ward MG, Barrowman NJ, Plint AC

Objective: To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children.

Systematic Review: Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma?

Visit

Kemp AM, Jaspan T, Griffiths J, Stoodley N, Mann MK, Tempest V, Maguire SA

Objective: To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT).

Systematic Review: Unexplainedfractures:child abuseorbone disease? A systematic review

Visit

Pandya NK, Baldwin K, Kamath AF, Wenger DR, Hosalkar HS

Child abuse and neglect (CAN) is a serious problem that has major implications for the welfare of the child involved. Unexplained fractures are of particular concern to the orthopaedic surgeon, who must often consider alternative diagnoses to CAN. We therefore (1) determined which bone diseases most commonly mimic CAN; (2) what types of osteogenesis imperfecta (OI) are most commonly confused with CAN and why; and (3) what specific findings in OI and bone disease render a mistaken diagnosis of CAN more likely.

Systematic Review: What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review

Visit

Kemp AM, Joshi AH, Mann M, Tempest V, Liu A, Holden S, Maguire S

Aim: Systematic review of 'What are the clinical and radiological characteristics of inflicted spinal injury?'

Systematic Review: Screening injured children for physical abuse or neglect in emergency departments: a systematic review

Visit

Woodman J, Lecky F, Hodes D, Pitt M, Taylor B, Gilbert R

Screening markers are used in emergency departments (EDs) to identify children who should be assessed for possible physicalabuseand neglect. We conducted three systematic reviews evaluating age, repeat attendance and injury type as markers for physicalabuseor neglect in injured children attending EDs.

Systematic Review: What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review

Visit

Kemp AM, Rajaram S, Mann M, Tempest V, Farewell D, Gawne-Cain ML, Jaspan T, M...

Aim: To investigate the optimal neuroradiological investigation strategy to identify inflicted brain injury (iBI).

Systematic Review: Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review

Visit

Maguire S, Pickerd N, Farewell D, Mann M, Tempest V, Kemp AM

Aim: A systematic review of the scientific literature to define clinical indicators distinguishing inflicted (iBI) from non-inflicted brain injury (niBI).

Systematic Review: A systematic review of the features that indicate intentional scalds in children

Visit

Maguire S, Moynihan S, Mann M, Potokar T, Kemp AM

Aim: To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds.

Systematic Review: Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries

Visit

Maguire S, Hunter B, Hunter L, Sibert JR, Mann M, Kemp AM

A torn labial frenum is widely regarded as pathognomonic of abuse. We systematically reviewed the evidence for this, and to define other intra-oral injuries found in physical abuse.

Systematic Review: Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review

Visit

Maguire S, Mann MK, Sibert J, Kemp A

Aim: To investigate what patterns of bruising are diagnostic or suggestive of child abuse by means of a systematic review.

Systematic Review: Can you age bruises accurately in children? A systematic review

Visit

Maguire S, Mann MK, Sibert J, Kemp A

Aim: To investigate whether it is possible to determine the age of a bruise in a child in clinical practice by means of a systematic review.

Key studies English (24) French All (24)

Key Study: The Prevalence of Bruising Among Infants in Pediatric Emergency Departments

Visit

Pierce MC, Magana JN, Kaczor K, Lorenz DJ, Meyers G, Bennett BL, Kanegaye JT

Bruising can indicate abuse for infants. Bruise prevalence among infants in the pediatric emergency department (ED) setting is unknown. Our objective is to determine prevalence of bruising, associated chief complaints, and frequency of abuse evaluations in previously healthy infants presenting to pediatric EDs.

Key Study: Prior opportunities to identify abuse in children with abusive head trauma

Visit

Letson MM, Cooper JN, Deans KJ, Scribano PV, Makoroff KL, Feldman KW, Berger RP

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities.

Key Study: Photographing Injuries in the Acute Care Setting: Development and Evaluation of a Standardized Protocol for Research, Forensics, and Clinical Practice

Visit

Bloemen EM, Rosen T, Cline Schiroo JA, Clark S, Mulcare MR, Stern ME, Mysliwi...

Our goal was to develop and evaluate a protocol for standardized photography of injuries that may be broadly applied.

Key Study: Patterns of bruising in preschool children--a longitudinal study

Visit

Kemp AM, Dunstan F, Nuttall D, Hamilton M, Collins P, Maguire S

This study aims to identify the prevalence and pattern of bruises in preschool children over time, and explore influential variables.

Key Study: Validation of a clinical prediction rule for pediatric abusive head trauma

Visit

Hymel KP, Armijo-Garcia V, Foster R, Frazier TN, Stoiko M, Christie LM, Harpe...

To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population.

Key Study: Additional injuries in young infants with concern for abuse and apparently isolated bruises

Visit

Harper NS, Feldman KW, Sugar NF, Anderst JD, Lindberg DM

Objective: To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising.

Key Study: Bruising in children who are assessed for suspected physical abuse

Visit

Kemp AM, Maguire SA, Nuttall D, Collins P, Dunstan F

Objective: To describe the characteristics of bruising and mode of presentation of children referred to the paediatric child protection team with suspected physical abuse (PA), and the extent to which these differ between the children where abuse was confirmed and those where it was excluded.

Key Study: Accuracy of a screening instrument to identify potential child abuse in emergency departments

Visit

Louwers EC, Korfage IJ, Affourtit MJ, Ruige M, van den Elzen AP, de Koning HJ...

This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs.

Key Study: Sentinel injuries: subtle findings of physical abuse

Visit

Petska HW, Sheets LK

This review outlines subtle findings of physical abuse in children.

Key Study: Missed opportunities to diagnose child physical abuse

Visit

Thorpe EL, Zuckerbraun NS, Wolford JE, Berger RP

This study aimed to determine the incidence of missed opportunities to diagnose abuse in a cohort of children with healing abusive fractures and to identify patterns present during previous medical visits, which could lead to an earlier diagnosis of abuse.

Key Study: Burns as a consequence of child maltreatment

Visit

Maguire SA, Okolie C, Kemp AM

This review outlines distinguishing characteristics between intentional and unintentional burns.

Key Study: Emergency department evaluation of child abuse

Visit

Leetch AN, Woolridge D

This review outlines emergency department evaluation of child abuse.

Key Study: Sentinel injuries in infants evaluated for child physical abuse

Visit

Sheets LK, Leach ME, Koszewski IJ, Lessmeier AM, Nugent M, Simpson P

Our objective was to determine how often abused infants have a previous history of "sentinel" injuries, compared with infants who were not abused.

Key Study: Evaluating for suspected child abuse: conditions that predispose to bleeding

Visit

Carpenter SL, Abshire TC, Anderst JD, Section on Hematology/Oncology and Comm...

This technical report reviews the major medical conditions that predispose to bruising/bleeding and should be considered when evaluating for abusive injury.

Key Study: An approach to child maltreatment documentation and participation in the court system

Visit

Ornstein AE

The present article offers practical advice about the approach to: documentation of a child abuse assessment; providing testimony and behaviour in the court system for the nonexpert; and, finally, guidance for individuals giving expert or opinion evidence for medicolegal purposes.

Key Study: Abusive head trauma: recognition and the essential investigation

Visit

Kemp AM

This article describes the evidence base behind the associated historical, clinical and neuroradiological features of abusive head trauma and spinal injury in physical abuse and sets out an algorithm of essential investigations that should be performed in any infant or young child where abusive head trauma is suspected.

Key Study: Femur fractures in the pediatric population:abuse or accidental trauma?

Visit

Baldwin K, Pandya NK, Wolfgruber H, Drummond DS, Hosalkar HS

We sought to determine whether accidental femur fractures in pediatric patients younger than age 4 could be distinguished from child abuse using a combination of presumed risk factors from the history, physical examination findings, radiographic findings, and age.

Key Study: Humerus fractures in the pediatric population: an algorithm to identify abuse

Visit

Pandya NK, Baldwin KD, Wolfgruber H, Drummond DS, Hosalkar HS

The purpose of this study was to produce an algorithm-based on statistical analysis that would allow clinicians to differentiate between humerusfracturesstemming fromabuseversusaccidentaltrauma.

Key Study: Delayed identification of pediatric abuse-related fractures

Visit

Ravichandiran N, Schuh S, Bejuk M, Al-Harthy N, Shouldice M, Au H, Boutis K

Because physicians may have difficulty distinguishingaccidentalfracturesfrom those that are caused byabuse, abusivefracturesmay be at risk for delayed recognition; therefore, the primary objective of this study was to determine how frequently abusivefractureswere missed by physicians during previous examinations. A secondary objective was to determine clinical predictors that are associated with unrecognizedabuse.

Key Study: Bruising characteristics discriminating physical child abuse from accidental trauma

Visit

Pierce MC, Kaczor K, Aldridge S, O'Flynn J, Lorenz DJ

Our objective was to conduct a pilot study to identify discriminating bruising characteristics and to model those findings into a decision tool for screening children at high risk forabuse.

Key Study: Child abuse and orthopaedic injury patterns:analysis at a level I pediatric trauma center

Visit

Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS

The purpose of our study was to describe the patterns of orthopaedic injury for child abuse cases detected in the large urban area that our institution serves, and to compare the injury profiles of these victims of child abuse to that of general (accidental) trauma patients seen in the emergency room and/or hospitalized during the same time period.

Key Study: Fractures in physical child abuse

Visit

Kemp AM

This review identifies some of the features that can be used to differentiate abusive fractures from the greater numbers of childhood fractures that are sustained from accidental trauma. Current investigation strategies and diagnostic dilemmas are discussed.

Key Study: Bruises in infants and toddlers: those who don't cruise rarely bruise

Visit

Sugar NF, Taylor JA, Feldman KW

To determine the frequency and location of bruises in normal infants and toddlers, and to determine the relationship of age and developmental stage to bruising.

Key Study: Analysis of missed cases of abusive head trauma

Visit

Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC

Objectives: To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis.

Key Study: The Prevalence of Bruising Among Infants in Pediatric Emergency Departments

Visit

Pierce MC, Magana JN, Kaczor K, Lorenz DJ, Meyers G, Bennett BL, Kanegaye JT

Bruising can indicate abuse for infants. Bruise prevalence among infants in the pediatric emergency department (ED) setting is unknown. Our objective is to determine prevalence of bruising, associated chief complaints, and frequency of abuse evaluations in previously healthy infants presenting to pediatric EDs.

Key Study: Prior opportunities to identify abuse in children with abusive head trauma

Visit

Letson MM, Cooper JN, Deans KJ, Scribano PV, Makoroff KL, Feldman KW, Berger RP

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities.

Key Study: Photographing Injuries in the Acute Care Setting: Development and Evaluation of a Standardized Protocol for Research, Forensics, and Clinical Practice

Visit

Bloemen EM, Rosen T, Cline Schiroo JA, Clark S, Mulcare MR, Stern ME, Mysliwi...

Our goal was to develop and evaluate a protocol for standardized photography of injuries that may be broadly applied.

Key Study: Patterns of bruising in preschool children--a longitudinal study

Visit

Kemp AM, Dunstan F, Nuttall D, Hamilton M, Collins P, Maguire S

This study aims to identify the prevalence and pattern of bruises in preschool children over time, and explore influential variables.

Key Study: Validation of a clinical prediction rule for pediatric abusive head trauma

Visit

Hymel KP, Armijo-Garcia V, Foster R, Frazier TN, Stoiko M, Christie LM, Harpe...

To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population.

Key Study: Additional injuries in young infants with concern for abuse and apparently isolated bruises

Visit

Harper NS, Feldman KW, Sugar NF, Anderst JD, Lindberg DM

Objective: To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising.

Key Study: Bruising in children who are assessed for suspected physical abuse

Visit

Kemp AM, Maguire SA, Nuttall D, Collins P, Dunstan F

Objective: To describe the characteristics of bruising and mode of presentation of children referred to the paediatric child protection team with suspected physical abuse (PA), and the extent to which these differ between the children where abuse was confirmed and those where it was excluded.

Key Study: Accuracy of a screening instrument to identify potential child abuse in emergency departments

Visit

Louwers EC, Korfage IJ, Affourtit MJ, Ruige M, van den Elzen AP, de Koning HJ...

This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs.

Key Study: Sentinel injuries: subtle findings of physical abuse

Visit

Petska HW, Sheets LK

This review outlines subtle findings of physical abuse in children.

Key Study: Missed opportunities to diagnose child physical abuse

Visit

Thorpe EL, Zuckerbraun NS, Wolford JE, Berger RP

This study aimed to determine the incidence of missed opportunities to diagnose abuse in a cohort of children with healing abusive fractures and to identify patterns present during previous medical visits, which could lead to an earlier diagnosis of abuse.

Key Study: Burns as a consequence of child maltreatment

Visit

Maguire SA, Okolie C, Kemp AM

This review outlines distinguishing characteristics between intentional and unintentional burns.

Key Study: Emergency department evaluation of child abuse

Visit

Leetch AN, Woolridge D

This review outlines emergency department evaluation of child abuse.

Key Study: Sentinel injuries in infants evaluated for child physical abuse

Visit

Sheets LK, Leach ME, Koszewski IJ, Lessmeier AM, Nugent M, Simpson P

Our objective was to determine how often abused infants have a previous history of "sentinel" injuries, compared with infants who were not abused.

Key Study: Evaluating for suspected child abuse: conditions that predispose to bleeding

Visit

Carpenter SL, Abshire TC, Anderst JD, Section on Hematology/Oncology and Comm...

This technical report reviews the major medical conditions that predispose to bruising/bleeding and should be considered when evaluating for abusive injury.

Key Study: An approach to child maltreatment documentation and participation in the court system

Visit

Ornstein AE

The present article offers practical advice about the approach to: documentation of a child abuse assessment; providing testimony and behaviour in the court system for the nonexpert; and, finally, guidance for individuals giving expert or opinion evidence for medicolegal purposes.

Key Study: Abusive head trauma: recognition and the essential investigation

Visit

Kemp AM

This article describes the evidence base behind the associated historical, clinical and neuroradiological features of abusive head trauma and spinal injury in physical abuse and sets out an algorithm of essential investigations that should be performed in any infant or young child where abusive head trauma is suspected.

Key Study: Femur fractures in the pediatric population:abuse or accidental trauma?

Visit

Baldwin K, Pandya NK, Wolfgruber H, Drummond DS, Hosalkar HS

We sought to determine whether accidental femur fractures in pediatric patients younger than age 4 could be distinguished from child abuse using a combination of presumed risk factors from the history, physical examination findings, radiographic findings, and age.

Key Study: Humerus fractures in the pediatric population: an algorithm to identify abuse

Visit

Pandya NK, Baldwin KD, Wolfgruber H, Drummond DS, Hosalkar HS

The purpose of this study was to produce an algorithm-based on statistical analysis that would allow clinicians to differentiate between humerusfracturesstemming fromabuseversusaccidentaltrauma.

Key Study: Delayed identification of pediatric abuse-related fractures

Visit

Ravichandiran N, Schuh S, Bejuk M, Al-Harthy N, Shouldice M, Au H, Boutis K

Because physicians may have difficulty distinguishingaccidentalfracturesfrom those that are caused byabuse, abusivefracturesmay be at risk for delayed recognition; therefore, the primary objective of this study was to determine how frequently abusivefractureswere missed by physicians during previous examinations. A secondary objective was to determine clinical predictors that are associated with unrecognizedabuse.

Key Study: Bruising characteristics discriminating physical child abuse from accidental trauma

Visit

Pierce MC, Kaczor K, Aldridge S, O'Flynn J, Lorenz DJ

Our objective was to conduct a pilot study to identify discriminating bruising characteristics and to model those findings into a decision tool for screening children at high risk forabuse.

Key Study: Child abuse and orthopaedic injury patterns:analysis at a level I pediatric trauma center

Visit

Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS

The purpose of our study was to describe the patterns of orthopaedic injury for child abuse cases detected in the large urban area that our institution serves, and to compare the injury profiles of these victims of child abuse to that of general (accidental) trauma patients seen in the emergency room and/or hospitalized during the same time period.

Key Study: Fractures in physical child abuse

Visit

Kemp AM

This review identifies some of the features that can be used to differentiate abusive fractures from the greater numbers of childhood fractures that are sustained from accidental trauma. Current investigation strategies and diagnostic dilemmas are discussed.

Key Study: Bruises in infants and toddlers: those who don't cruise rarely bruise

Visit

Sugar NF, Taylor JA, Feldman KW

To determine the frequency and location of bruises in normal infants and toddlers, and to determine the relationship of age and developmental stage to bruising.

Key Study: Analysis of missed cases of abusive head trauma

Visit

Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC

Objectives: To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis.