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

ormation such as patient's neurological status, results of radiological studies, and ophthalmologic exam findings to classify patients as either "Definite Abuse" or "Not Definite Abuse." They then went back and looked at initial presenting histories for these patients so that they could assess whether those histories (the information that caregivers or parents provided) were a reliable predictor of Definite Abuse.

Additionally, researchers found that among the subgroup of patients with persistent neurologic abnormality at hospital discharge, those who did not have a history of high-impact (defined as a fall greater than 3 feet) trauma were all victims of child abuse. The researchers combined cases that reported no history of trauma with those that reported a history of low-impact (defined as a fall from less than 3 feet) trauma and found that, in both cases, these reports were predictive for abuse. This is consistent with data from a prior Children's Hospital study that showed that low-impact trauma is unlikely to result in neurological impairment.

The third relevant finding was that when caregivers or parents attributed injuries to their own vigorous attempts to resuscitate a child, abuse was the cause of injuries in every case. Lastly, in cases where parents changed their stories or whose reported histories changed over the course of their treatment at the hospital, abuse was again determined to be the cause of injury in all cases.

"These findings underscore how important it is for caregivers to take accurate histories so that the likelihood of abuse can most accurately be assessed," says Andrea. Vandeven, MD, MPH, assistant in Medicine and director of Children's Child Protection Team. "These guideposts can be useful for caregivers who are unfortunately put in the situation of assessing whether abuse has occurred all too often."

Over 3 million cases of child abuse and neglect are reported annually, a rate of 44 per 1000 children. Each
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Contact: Susan Craig
susan.craig@tch.harvard.edu
617-355-6420
Children's Hospital Boston
3-Mar-2003


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