Non accidental trauma

IMPORTANCE: Traumatic brain injury (TBI) is known to cause widespread neural disruption in the cerebrum. However, less is known about the association of TBI with cerebellar structure and how such changes may alter executive functioning. OBJECTIVE: To investigate alterations in subregional cerebellum volume and cerebral white matter microstructure after pediatric TBI and examine subsequent changes in executive function. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study combined 12 data sets (collected between 2006 and 2020) from 9 sites in the Enhancing Neuroimaging Genetics Through Meta-Analysis Consortium Pediatric TBI working group in a mega-analysis of cerebellar structure...

Forensic autopsy is an important tool for the proper management of non-natural deaths in minors. However, it seems that autopsy in minors is a practice which may not be performed routinely. In this framework, we conducted a study analyzing autopsies of minors (under 18 years of age in Italy) performed at the Institute of Forensic Medicine in Milan in the period 2001-2019. For the period 2015-2019, we extrapolated all deaths due to non-natural causes in minors to investigate how many and which of these deaths were not subjected to forensic autopsy...

BACKGROUND: Accidental hypothermia designates an unintentional drop in body temperature below 35 °C. There is a major risk of ventricular fibrillation below 28 °C and cardiac arrest is almost inevitable below 24 °C. In such cases, conventional cardiopulmonary resuscitation is often inefficient. In urban areas with temperate climates, characterized by mild year-round temperatures, the outcome of patients with refractory hypothermic out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) remains uncertain...

Introduction Non-accidental trauma (NAT) is a leading cause of pediatric injury and death. When NAT is suspected in children under the age of 24 months, the American Academy of Pediatrics (AAP) recommends using skeletal surveys (SS) to identify acute, healing, or old fractures and to repeat the SS approximately two weeks after initial imaging as acute fractures can sometimes not be seen on initial imaging. In this study, we determined the yield of initial and follow-up SS obtained for suspected NAT in children under the age of 24 months at a regional referral hospital...

BACKGROUND: Transphyseal humeral separations (TPHS) are rare injuries often associated with non-accidental trauma, necessitating accurate diagnosis. This study aims to assess the accuracy of diagnosis of TPHS. METHODS: A retrospective review was conducted at five academic pediatric institutions to identify all surgically treated TPHS in patients up to 4 years of age over a 25-year period. Demographics, misdiagnosis rates, and reported misdiagnoses were noted. Comparative analyses were performed to analyze the effects of patient age and injury mechanism on misdiagnosis rates...

PURPOSE: We explored the application of a machine learning algorithm for the timely detection of potential abusive head trauma (AHT) using the first free-text note of an encounter and demographic information. METHODS: First free-text physician notes and demographic information were collected for children under 5 years of age at a Level 1 Trauma Center. The control group, which included patients with head/neck injury, was compared to those with AHT diagnosed by the Child Protective Team...

BACKGROUND Hemangiomas are defined as benign soft tissue vascular tumors that are histologically classified as capillary, cavernous, or mixed types. Hemangiomas can also be described based on clinical appearance as superficial, mixed, or deep lesions. Following a thorough search, only 3 case reports of superficial protruding lip mass were found in the literature. Other cases of tongue hemangioma have been reported in infants or young toddlers, and only rarely in adults. CASE REPORT The first case was a 43-year-old pregnant woman, with an unremarkable medical and surgical history, in the second trimester who presented to the Otolaryngology Clinic with a chief concern of a progressively growing lesion, measuring 0...

INTRODUCTION AND IMPORTANCE: Pulmonary hernia is a rare disease caused mostly by chest trauma. Patients often present with non-specific signs and symptoms. Currently, there is no unified approach to treating it. For asymptomatic pulmonary hernias, conservative treatment has been chosen in the past. However, the increasing number of cases has shown that surgery has a more positive effect on some patients with asymptomatic pulmonary hernias. CASE PRESENTATION: A 63-year-old female patient who accidentally fell from an agricultural vehicle while doing farm work presented with back pain and lower limb paralysis...

This case report highlights the need for syphilis re-testing during pregnancy and at labor and delivery when there are high-risk factors present. Our patient, an infant, was evaluated for non-accidental trauma because of the presence of multiple fractures, which could be one of the presentations of congenital syphilis. A high index of suspicion is required for syphilis when an infant presents with multiple fractures. Syphilis testing and re-testing guidelines should be followed strictly so that pregnant women are appropriately treated to prevent congenital syphilis...

OBJECTIVE: Trauma can cause physical morbidity and even result in death. Besides, it can lead to serious mental problems as well. The most well-known mental health problem is post-traumatic stress disorder. Through this study, it was primarily aimed to find out whether the severity of physical trauma is effective on post-traumatic stress disorder and other risk factors if any. METHODS: The reports of the patients who were transferred to the Turkish Council of Forensic Medicine Third Speciality Board between January 01, 2019, and December 31, 2020, for post-traumatic invalidity or disability evaluation and whose psychiatric examinations were performed were retrospectively analyzed in the electronic environment...

BACKGROUND: Regionalized care for burn-injured patients requires accurate triage. In 2016, we implemented a tele-triage system for acute burn consultations. We evaluated resource utilization following implementation, hypothesizing that this system would reduce short stay admissions and prioritize inpatient care for those with higher burn severity. METHODS: We conducted a retrospective study of all transferred patients with acute burn injuries from 1/1/2010-12/31/2015 and 1/1/2017-12/31/2019...

The Canadian Association of Radiologists (CAR) Trauma Expert Panel consists of adult and pediatric emergency and trauma radiologists, emergency physicians, a family physician, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 21 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for 1 or more of these clinical/diagnostic scenarios. Recommendations from 49 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 50 recommendation statements across the 21 scenarios related to the evaluation of traumatic injuries...

Objective:  Although accessory sutures are considered to be relatively rare, the consequences of a missed diagnosis are profound. Distinguishing between accessory sutures and cranial fractures can be difficult, especially in cases of suspected non-accidental trauma. High-resolution imaging is the best way to discern between two- and three-dimensional computerized tomography (3D CT) is considered the preferred method for evaluation. The goal of this study was to determine the impact of 3D CT scans in distinguishing between accessory sutures and cranial fractures in suspected child abuse cases in a rural community and the importance of early detection in such cases, as well as call attention to the consequences of initial misinterpretation...

St. Zenobius (337-417), second only to John the Baptist as a Patron Saint of Florence, revived a 5-year-old boy who appeared to be dead after he was struck by an ox cart, one of his several acts of resurrection for which he was revered. His miracles inspired some of the greatest artists of the Florentine Republic, including Ghiberti and Botticelli. Celebrated from Late Antiquity as protector of the city, St. Zenobius might also be considered the guardian of injured children. But it wasn't the only instance where he had to revivify an injured child: a boy died while he was entrusted to the saint's care, a circumstance that today would qualify as non-accidental trauma (NAT) from neglect and prompt an investigation from the police and child protective services...

OBJECTIVES: Transferring paediatric patients with suspected abusive head trauma (AHT) to paediatric neurosurgical centres, disrupts safeguarding investigations. Therefore, it is desirable that suspected AHTs are transferred only when clinically necessary. The aim of this study was to describe referral patterns of patients referred to a tertiary paediatric neurosurgical centre with suspected AHT, with the view of informing future transfer of AHT patients. DESIGN: A retrospective review was performed of all suspected AHT patients referred to the University Hospital of Wales between 2012 and 2021...

Both blunt and penetrating chest trauma in children are less common than in adults but cause severe acute morbidity and mortality. As the literature suggests, pulmonary contusion is the most common chest injury in children, occurring in more than half of all blunt chest trauma cases. Even patients with blunt injuries are likely to have a longer hospital stay. The difference in physiological and anatomical variations in children compared to adults makes it more difficult from the diagnosis, management, and monitoring perspectives...

Non-ossifying fibromas are extremely rare in the upper extremity, such as those in the radius and humerus. The treatment of completely displaced fractures following non-ossifying fibromas in the radius has not been reported. We present the case of a pathological fracture caused by a non-ossifying fibroma in the radius treated using external fixation. The patient was a 10-year-old girl who presented to our hospital with right forearm pain after an accidental fall. She had no remarkable medical history. Radiographs and computed tomography showed a pathological fracture through osteolytic lesions with sclerotic rims in the diaphysis of the radius, suggesting a pathological fracture through a non-ossifying fibroma in the radius...

Subdural hemorrhages (SDHs) in children are most often observed in abusive head trauma (AHT), a distinct form of traumatic brain injury, but they may occur in other conditions as well, typically with clear signs and symptoms of an alternative diagnosis. We present a case of an infant whose SDH initially raised the question of AHT, but multidisciplinary evaluation identified multiple abnormalities, including rash, macrocephaly, growth failure, and elevated inflammatory markers, which were all atypical for trauma...

Non-accidental trauma (NAT) is deadly and difficult to predict. Transformer models pretrained on large datasets have recently produced state of the art performance on diverse prediction tasks, but the optimal pretraining strategies for diagnostic predictions are not known. Here we report the development and external validation of Pretrained and Adapted BERT for Longitudinal Outcomes (PABLO), a transformer-based deep learning model with multitask clinical pretraining, to identify patients who will receive a diagnosis of NAT in the next year...

AIM: The COVID-19 pandemic drastically altered human behaviour and socialisation and may have created an environment that could lead to increased incidence of domestic abuse and non-accidental trauma, or child physical abuse (CPA). Initial reports about the effect of the COVID-19 pandemic on the rates of CPA have been mixed. The purpose of this study is to describe the effects of COVID-19 on rates of CPA in a large metropolitan paediatric hospital and level I paediatric trauma centre...