No mention of trauma as cause of head injury is likely abuse

BOSTON - Researchers in the Emergency Department at Children's Hospital Boston have found that infants who present for medical care with a serious head injury and no mention of trauma to explain the injury are highly likely to be victims of child abuse. These findings are expected to be helpful for physicians when assessing whether child abuse is a factor in head injuries. The study's strength is that it validates some existing presumptions that physicians use to identify abuse. The study is published in the March issue of the journal Pediatrics.

The researchers found that when a child presented with neurological symptoms after head injury and parents or caregivers reported no history of trauma, such as a fall or being hit with a hard object, that the injury was highly likely to be caused by abuse. In medical terms, the history is the initial report of what happened prior to injury.

"In every single case where there was no history of trauma and the child ended up with neurological damage, it was later determined that the injury was caused by abuse," says Joeli Hettler, MD, assistant in Emergency Medicine and lead author of the study. "Either the parents did not 'make up a story' of how their kids were hurt, or their initial claims of not knowing what happened or of a minor injury, did not coincide with the observed injuries."

In order to assess whether abuse has occurred, physicians evaluate medical test results and take a history (an account of the patient's past and present health and family and personal background). Children's researchers set out to assess this history -- or report of what happened -- to see if it could effectively predict whether a child's injury was caused by abuse.

To do this, researchers looked retrospectively at 200 patient charts of children from birth to age 3 who were admitted to Children's with traumatic intracranial hemorrhage or serious bleeding in the head from 1993-2000. They looked at medical inf

Contact: Susan Craig
Children's Hospital Boston

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