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Children with sentinel injuries often diagnosed with abuse
Abuse diagnoses were common in children presenting with putative sentinel injuries, such as rib fractures, abdominal trauma and intracranial hemorrhaging, according to research in Pediatrics.
“Several so-called sentinel injuries have been suggested to be associated with high rates of abuse, and to imply the need for routine testing for other, occult traumatic injuries,” Daniel M. Lindberg, MD, of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect in Denver, Colorado, and colleagues wrote. “Among young children found to have putative sentinel injuries without a motor vehicle collision at leading children’s hospitals, rates of diagnosed abuse were high.”
The researchers analyzed Pediatric Health Information System data for 30,355 children aged younger than 24 months with putative sentinel injuries presenting at EDs. They examined testing methods and determined rates for how often children with these injuries received an abuse diagnosis. The overall rate of an abuse diagnosis was 0.17% among all visits for children in the study cohort.
Among children with at least one putative sentinel injury, the rates of abuse diagnosis ranged from 3.5% in patients aged younger than 6 months with burns, to 56.1% in children aged younger than 24 months with rib fractures. Abuse also was diagnosed in head-related injuries, with 26.3% of patients aged younger than 12 months presenting with intracranial hemorrhaging, and 4.3% of patients with isolated skull fractures.
The researchers said that the use of skeletal survey and other testing methods that can diagnose putative sentinel injuries differed widely between hospitals based on injury type. Patients aged younger than 24 months who presented with rib fractures were most likely to receive a skeletal survey (81.5%) or neuroimaging testing (90.6%).
“Together, these facts suggest that increased, routine, or protocolized testing for children with these injuries can identify other children with abuse that might otherwise be missed,” Lindberg and colleagues wrote. “These results support future trials of protocolized evaluations for children with these putative sentinel injuries.” – by David Costill
Disclosure: Lindberg reports providing paid expert testimony in cases of alleged child maltreatment. Please the full study for a list of all other authors’ relevant financial disclosures.
