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Infant abusive head trauma

So Young Kim, Linda A Morgan, Andrew J Baldwin, Donny W Suh
BACKGROUND: Retinal hemorrhage (RH) is one of the hallmarks of abusive head trauma (AHT); however, RH is also encountered with normal vaginal deliveries (NVD) and thus presents the clinician with a diagnostic dilemma. The purpose of this study was to compare RHs in AHT with those of NVD. METHODS: Records of with AHT and NVD infants with RH evaluated from 2013 to 2015 were reviewed retrospectively. Pattern, size, extent, and severity were compared using RetCam images...
March 13, 2018: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Shaylan K Govind, Neil H Merritt
BACKGROUND: The objective of our study was to identify the most common mechanisms of injury leading to death in our pediatric population. METHODS: A retrospective cohort of fatally injured children 0-17 years old treated at our trauma center during 2000-2015. RESULTS: The mortality rate in our population was 8% (n = 103). Fifty-five percent were male. The majority (76%) of fatal injuries were blunt. Overall, motor vehicle collisions (MVCs) were the most common mechanism of injury (61%), followed by assault/abuse (9%)...
March 6, 2018: American Journal of Surgery
Yangyang R Yu, Annalyn S DeMello, Christopher S Greeley, Charles S Cox, Bindi J Naik-Mathuria, David E Wesson
PURPOSE: This study examines non-accidental trauma (NAT) fatalities as a percentage of all injury fatalities and identifies injury patterns in NAT admissions to two level 1 pediatric trauma centers. METHODS: We reviewed all children (<5years old) treated for NAT from 2011 to 2015. Patient demographics, injury sites, and survival were obtained from both institutional trauma registries. RESULTS: Of 4623 trauma admissions, 557 (12%) were due to NAT...
February 10, 2018: Journal of Pediatric Surgery
Geoffrey David Debelle, Sabine Maguire, Patrick Watts, Rosa Nieto Hernandez, Alison Mary Kemp
The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) has recently published what they purported to be a systematic review of the literature on 'isolated traumatic shaking' in infants, concluding that 'there is limited evidence that the so-called triad (encephalopathy, subdural haemorrhage, retinal haemorrhage) and therefore its components can be associated with traumatic shaking'. This flawed report, from a national body, demands a robust response. The conclusions of the original report have the potential to undermine medico-legal practice...
March 6, 2018: Archives of Disease in Childhood
Sarah V Duzinski, Luis M Guevara, Amanda N Barczyk, Nilda M Garcia, Jane L Cassel, Karla A Lawson
INTRODUCTION: This study aimed to evaluate participants' knowledge of and intent to share key messages of the Period of PURPLE Crying abusive head trauma prevention program among a majority Spanish-speaking population. METHODS: This study was a retrospective review of a postintervention survey administered in the perinatal unit of a community birthing hospital. Surveys were administered to mothers of newborns by perinatal nurses as part of routine process evaluation prior to hospital discharge between May 30, 2014, and May 15, 2015...
January 1, 2018: Hispanic Health Care International: the Official Journal of the National Association of Hispanic Nurses
Clémence Delteil, David Meyronet, Andre Maues de Paula, Anne Jouvet, Marie-Dominique Piercecchi-Marti
According to the French High Authority for Health, sudden unexpected death in infants (SUDI) is defined as "a sudden death that occurs in an infant, whereas nothing in its known history could have predicted it". This is an exclusion diagnosis. There are great interregional disparities despite the professional recommendations established in February 2007. For the examination of the brain, instructions are not adapted to current and research practice. The role of the pathologist, like anyone involved in SUDI, is to eliminate an abuse head trauma and to determine the cause of death...
February 8, 2018: Annales de Pathologie
Krishanthy Sornalingam, Arundhati Dev Borman, Jane Ashworth
The association between abusive head trauma and retinal hemorrhages is well documented. As such, ophthalmic review in suspected nonaccidental injury has become routine. However, there is a paucity of reports focusing on ocular trauma and retinal detachment presenting as unilateral findings in nonaccidental injury and in the absence of other signs of physical abuse. This report identifies 2 suspected cases of nonaccidental injury in infants presenting to a tertiary care center with retinal detachment presumed secondary to severe unilateral direct ocular trauma...
January 31, 2018: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Henry T Puls, James D Anderst, Jessica L Bettenhausen, Abbey Masonbrink, Jessica L Markham, Laura Plencner, Molly Krager, Matthew B Johnson, Jacqueline M Walker, Christopher S Greeley, Matthew Hall
OBJECTIVES: To compare rates of previous inpatient visits among children hospitalized with child physical abuse (CPA) with controls as well as between individual abuse types. METHODS: In this study, we used the Pediatric Health Information System administrative database of 44 children's hospitals. Children <6 years of age hospitalized with CPA between January 1, 2011, and September 30, 2015, were identified by discharge codes and propensity matched to accidental injury controls...
January 25, 2018: Hospital Pediatrics
Guoxiang Wang, Yi Ping Zhang, Zhongwen Gao, Lisa B E Shields, Fang Li, Tianci Chu, Huayi Lv, Thomas Moriarty, Xiao-Ming Xu, Xiaoyu Yang, Christopher B Shields, Jun Cai
Abusive head trauma (AHT) is the leading cause of death from trauma in infants and young children. An AHT animal model was developed on 12-day-old mice subjected to 90° head extension-flexion sagittal shaking repeated 30, 60, 80 and 100 times. The mortality and time until return of consciousness were dependent on the number of repeats and severity of the injury. Following 60 episodes of repeated head shakings, the pups demonstrated apnea and/or bradycardia immediately after injury. Acute oxygen desaturation was observed by pulse oximetry during respiratory and cardiac suppression...
January 30, 2018: Disease Models & Mechanisms
T O Lintern, M P Nash, P Kelly, F H Bloomfield, A J Taberner, P M F Nielsen
Abusive head trauma (AHT) is a potentially fatal result of child abuse, but the mechanisms by which injury occur are often unclear. To investigate the contention that shaking alone can elicit the injuries observed, effective computational models are necessary. The aim of this study was to develop a probabilistic model describing infant head kinematics in AHT. A deterministic model incorporating an infant's mechanical properties, subjected to different shaking motions, was developed in OpenSim. A Monte Carlo analysis was used to simulate the range of infant kinematics produced as a result of varying both the mechanical properties and the type of shaking motions...
December 2017: Computer Methods in Biomechanics and Biomedical Engineering
Jacob Andersson, Ingemar Thiblin
AIM: The validity of the diagnostic criteria for abusive head trauma (AHT) and its attributes has been widely debated. This national study investigated the possibility of false-positive and false-negative cases of fatal AHT in Sweden. METHOD: This was a retrospective evaluation of the records of 733 deceased infants up to the age of 365 days who were examined during 1994-2013 at the six forensic medicine departments. All the records were scrutinised for possible cases of AHT...
March 2018: Acta Paediatrica
Emma C Cheshire, Roger D G Malcomson, Peng Sun, Evgeny M Mirkes, Jasmin M Amoroso, Guy N Rutty
In the first years of life, subdural haemorrhage (SDH) within the cranial cavity can occur through accidental and non-accidental mechanisms as well as from birth-related injury. This type of bleeding is the most common finding in victims of abusive head trauma (AHT). Historically, the most frequent cause of SDHs in infancy is suggested to be traumatic damage to bridging veins traversing from the brain to the dural membrane. However, several alternative hypotheses have been suggested for the cause and origin of subdural bleeding...
October 26, 2017: International Journal of Legal Medicine
Francesca Louise Payne, Daphin Nazareth Fernandez, Lucy Jenner, Siba Prosad Paul
Abusive head trauma (AHT) describes an injury to the head caused by a deliberate impact or shaking by a parent or carer. It can cause significant morbidity and mortality in infants, and is most commonly seen in those aged under 2 years. The initial presentation of AHT can include vague symptoms and the correct diagnosis may be missed by health professionals. Subdural haematoma, brain oedema and retinal haemorrhages are well-known features associated with AHT. However, other conditions such as birth trauma, accidental falls in infants and bleeding disorders can all mimic AHT, thus making its recognition difficult...
September 28, 2017: British Journal of Nursing: BJN
Naz Raoof, Susana Pereira, Shuan Dai, Jocelyn Neutze, Cameron Charles Grant, Patrick Kelly
AIMS: It has been hypothesised that paroxysmal coughing in infantile pertussis (whooping cough) could produce retinal haemorrhages identical to those seen in abusive head trauma. We aimed to test this hypothesis. METHODS: This is a prospective study of infants hospitalised with pertussis in Auckland, New Zealand, from 2009 to 2014. The clinical severity of pertussis was categorised. All infants recruited had retinal examination through dilated pupils by the paediatric ophthalmology service using an indirect ophthalmoscope...
December 2017: Archives of Disease in Childhood
Joseph Scheller
No abstract text is available yet for this article.
August 22, 2017: Acta Paediatrica
Jennifer A Fraser, Tara Flemington, Thi Ngoc Diep Doan, Minh Tu Van Hoang, Thi Le Binh Doan, Manh Tuan Ha
AIM: This study presents results from an intervention designed to improve identification and response to abusive head trauma in a tertiary paediatric hospital in Vietnam. METHODS: One hundred and sixteen healthcare professionals (paediatric medical and nursing staff) completed a clinical training programme and participated in its evaluation. A pre-post-test and follow-up design was used to evaluate the outcomes. Questionnaires were used to collect data prior to training, at six weeks and at six months...
October 2017: Acta Paediatrica
Carolyn V Isaac, Jered B Cornelison, Rudolph J Castellani, Joyce L deJong
Pediatric abusive head trauma is a challenging subject across many disciplines. Of particular importance is the identification of mimics of abuse, so cause and manner of death can be properly assigned. We present the case of suspected child abuse involving an infant who presented unresponsive to the hospital with hypoglycemia, hypothermia, and bilateral parietal fractures. An autopsy revealed fractures associated with organizing scalp hemorrhage and gross leptomeningeal congestion and hemorrhage. The fractures were circular with external displacement, rounded margins, and subperiosteal new bone formation indicative of healing...
June 12, 2017: Journal of Forensic Sciences
Sandra L Wootton-Gorges, Bruno P Soares, Adina L Alazraki, Sudha A Anupindi, Jeffrey P Blount, Timothy N Booth, Molly E Dempsey, Richard A Falcone, Laura L Hayes, Abhaya V Kulkarni, Sonia Partap, Cynthia K Rigsby, Maura E Ryan, Nabile M Safdar, Andrew T Trout, Roger F Widmann, Boaz K Karmazyn, Susan Palasis
The youngest children, particularly in the first year of life, are the most vulnerable to physical abuse. Skeletal survey is the universal screening examination in children 24 months of age and younger. Fractures occur in over half of abused children. Rib fractures may be the only abnormality in about 30%. A repeat limited skeletal survey after 2 weeks can detect additional fractures and can provide fracture dating information. The type and extent of additional imaging for pediatric patients being evaluated for suspected physical abuse depends on the age of the child, the presence of neurologic signs and symptoms, evidence of thoracic or abdominopelvic injuries, and social considerations...
May 2017: Journal of the American College of Radiology: JACR
Steven Lucas, Anna Bärtås, Anna-Karin Edstedt Bonamy, Lisa Törnudd, Peter Wide, Gabriel Otterman
No abstract text is available yet for this article.
April 19, 2017: Acta Paediatrica
Rachel Pardes Berger, Brian J Pak, Mariya D Kolesnikova, Janet Fromkin, Richard Saladino, Bruce E Herman, Mary Clyde Pierce, David Englert, Paul T Smith, Patrick M Kochanek
Importance: Abusive head trauma is the leading cause of death from physical abuse. Missing the diagnosis of abusive head trauma, particularly in its mild form, is common and contributes to increased morbidity and mortality. Serum biomarkers may have potential as quantitative point-of-care screening tools to alert physicians to the possibility of intracranial hemorrhage. Objective: To identify and validate a set of biomarkers that could be the basis of a multivariable model to identify intracranial hemorrhage in well-appearing infants using the Ziplex System...
June 5, 2017: JAMA Pediatrics
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