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Nonaccidental Injury in Pediatric Patients: Detection, Evaluation, and Treatment (Trauma CME)

July 2017

Inside This Issue

We know that approximately one-third of the children who died from nonaccidental injuries had been previously evaluated for injuries that healthcare providers did not recognize as abuse. This issue outlines evidence-based strategies to help emergency clinicians recognize signs of abuse while dealing sensitively with caregivers. In this issue, you will learn to:

  • Recognize sentinel injuries
  • Identify injury patterns that are specific for abuse
  • Describe the range of findings present in abusive head trauma
  • Take a patient history that will reveal key indicators of abuse
  • Order diagnostic studies that reveal abuse, while minimizing radiation
Keywords: nonaccidental injury, NAI, nonaccidental trauma, NAT, abuse, child abuse, physical abuse, maltreatment, neglect, inflicted injury, Child Protective Services, abusive head trauma, PredAHT, Pittsburgh Infant Brain Injury Score, PIBIS, hypoxic-ischemic injury, cutaneous injury, burns, scald burns, submersion burns, bruising, bruises, clustered bruising, patterned bruising, thoracoabdominal injury, intraoral injury, oral injury, sentinel injury, abdominal injury, thoracic injury, fractures, skeletal injury, skeletal survey, domestic violence, intimate partner violence, shaken baby syndrome, intracranial hemorrhage, subdural hematoma, subarachnoid hemorrhage, retinal hemorrhage, TEN-4 decision rule, emergency department, pediatric, child
 
Points
  • Though abuse may be diagnosed when a child is evaluated for a specific injury, findings such as bruising may be discovered on a routine physical examination conducted for other presenting complaints.
  • In cases concerning for abuse, careful documentation is important; document words and statements in quotation marks, when possible.

Pearl

  • About one-third of children who died from abuse were previously seen by a healthcare provider for injuries that were not recognized as abuse; abuse cases are more often missed on first presentation to the emergency department due to provider biases and the misconception that abuse only happens in certain populations.
 
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Last Modified: 07/23/2017
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