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Nonaccidental trauma

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https://www.readbyqxmd.com/read/29622334/pediatric-major-head-injury-not-a-minor-problem
#1
REVIEW
Aaron N Leetch, Bryan Wilson
Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29599113/vomiting-with-head-trauma-and-risk-of-traumatic-brain-injury
#2
Meredith L Borland, Stuart R Dalziel, Natalie Phillips, Sarah Dalton, Mark D Lyttle, Silvia Bressan, Ed Oakley, Stephen J C Hearps, Amit Kochar, Jeremy Furyk, John A Cheek, Jocelyn Neutze, Franz E Babl
OBJECTIVES: To determine the prevalence of traumatic brain injuries in children who vomit after head injury and identify variables from published clinical decision rules (CDRs) that predict increased risk. METHODS: Secondary analysis of the Australasian Paediatric Head Injury Rule Study. Vomiting characteristics were assessed and correlated with CDR predictors and the presence of clinically important traumatic brain injury (ciTBI) or traumatic brain injury on computed tomography (TBI-CT)...
March 29, 2018: Pediatrics
https://www.readbyqxmd.com/read/29448121/neonatal-distal-femoral-physeal-injury-secondary-to-mechanical-trauma-of-birth-a-case-report
#3
Arie Franco, Apeksha Chaturvedi
Physeal injuries occurring secondary to neonatal birth-related trauma are rare entities. Most reported cases of physeal injury involve the distal humerus with only a few published case reports of proximal femoral involvement. So far, we have found only one reported case of neonatal distal femoral epiphysiolysis following Caesarean section. We hereby report a unique case of distal femoral physeal injury with at least partial epiphyseal separation following an uneventful, spontaneous vaginal delivery. Given the uneventful delivery and no known prenatal risk factors, the imaging findings were initially not recognized as being secondary to birth-related injury...
February 7, 2018: Clinical Imaging
https://www.readbyqxmd.com/read/29410140/nonaccidental-injury-presenting-as-unilateral-retinal-detachment-in-two-infants
#4
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
https://www.readbyqxmd.com/read/29393734/retrospective-analysis-of-necropsy-reports-suggestive-of-abuse-in-dogs-and-cats
#5
Daniel C Almeida, Sheila M F Torres, Arno Wuenschmann
OBJECTIVE To identify historical and necropsy findings suggestive of neglect or abuse of dogs and cats by retrospective analysis of necropsy reports from a veterinary diagnostic laboratory. DESIGN Retrospective cohort study. SAMPLE 119 necropsy reports of dogs and cats. PROCEDURES Necropsy reports from February 2001 to May 2012 were electronically searched to identify potential animal abuse or neglect cases. Cases were selected and categorized according to a previously proposed method for classification of animal abuse...
February 15, 2018: Journal of the American Veterinary Medical Association
https://www.readbyqxmd.com/read/29356793/fracture-patterns-differ-between-osteogenesis-imperfecta-and-routine-pediatric-fractures
#6
Kranti V Peddada, Brian T Sullivan, Adam Margalit, Paul D Sponseller
BACKGROUND: It is important to estimate the likelihood that a pediatric fracture is caused by osteogenesis imperfecta (OI), especially the least severe type of OI (type 1). METHODS: We reviewed records of 29,101 pediatric patients with fractures from 2003 through 2015. We included patients with closed fractures not resulting from motor vehicle accidents, gunshot wounds, nonaccidental trauma, or bone lesions. Patients with OI of any type were identified through International Classification of Diseases-9 code...
April 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29299097/paravertebral-calcification-as-a-potential-indicator-for-nonaccidental-trauma
#7
Katsuaki Kojima, Jennifer Nimtz, Steven W Martin, Stephen R Guertin, Ellen C Cavenagh
We report a case of nonaccidental trauma (NAT) involving a 23-month-old boy who presented with seizures, acute subarachnoid hemorrhage, and acute subdural hemorrhage. Ophthalmologic examination showed bilateral intraretinal hemorrhages. Further evaluation revealed that he had bilateral thoracolumbar paravertebral calcifications. The Children's Protective Services agency was involved in the case. The child was discharged to an inpatient rehabilitation facility. Vertebral fracture associated with paravertebral calcification has been reported as a sign of NAT...
July 2017: Journal of Radiology Case Reports
https://www.readbyqxmd.com/read/29244703/the-risk-of-assuming-abuse-in-an-infant-with-an-isolated-metaphyseal-lesion-a-case-report
#8
Kirsten Norrell, William Hennrikus
CASE: The classic metaphyseal lesion, or corner fracture, is considered a strong indicator of nonaccidental trauma. In the present case, the parents brought their 8-month-old boy to a community hospital after he stopped crawling on the right leg. A knee radiograph demonstrated an isolated metaphyseal lesion, which prompted concern for child abuse. The patient was transferred to the nearest academic medical center; the pediatric radiology expert in child abuse determined that the lesion was a normal variant and not the result of abuse...
July 2017: JBJS Case Connector
https://www.readbyqxmd.com/read/29214091/keeping-an-open-mind-cognitive-bias-in-the-evaluation-of-an-infant-with-posterior-lateral-rib-fractures
#9
Katie Johnson, Donald Chris Derauf, Raymond Stetson, Paul Galardy, Jason Homme
A four-month-old former premature male is incidentally found to have posterior-lateral rib fractures during evaluation of a febrile illness. This finding led to the initiation of a workup for nonaccidental trauma. A thorough history and physical exam ultimately led to the diagnosis, which was not related to abuse. This case highlights a rare sequela of patent ductus arteriosus repair, cautions medical teams to remain aware of how cognitive bias can affect diagnostic decision-making, and emphasizes the importance of a thorough history, physical exam, and medical record review in cases of suspected nonaccidental trauma...
2017: Case Reports in Pediatrics
https://www.readbyqxmd.com/read/29212880/standardizing-the-evaluation-of-nonaccidental-trauma-in-a-large-pediatric-emergency-department
#10
Lauren C Riney, Theresa M Frey, Emily T Fain, Elena M Duma, Berkeley L Bennett, Eileen Murtagh Kurowski
BACKGROUND AND OBJECTIVES: Variability exists in the evaluation of nonaccidental trauma (NAT) in the pediatric emergency department because of misconceptions and individual bias of clinicians. Further maltreatment, injury, and death can ensue if these children are not evaluated appropriately. The implementation of guidelines for NAT evaluation has been successful in decreasing differences in care as influenced by race and ethnicity of the patient and their family. Our Specific, Measurable, Achievable, Realistic, and Timely aim was to increase the percent of patients evaluated in the emergency department for NAT who receive guideline-adherent evaluation from 47% to 80% by December 31, 2016...
January 2018: Pediatrics
https://www.readbyqxmd.com/read/29153813/surgical-stabilization-of-rib-fractures-in-a-6-year-old-child-after-blunt-trauma
#11
Zaid M Abdelsattar, Michael B Ishitani, Brian D Kim
When identified, rib fractures in children are associated with high-energy trauma, nonaccidental trauma, or both. Traditionally, the optimal management of rib fractures in children is supportive care. In this case report, we present a 6-year-old boy who underwent surgical rib fixation for multiple displaced and comminuted rib fractures after being stepped on by a horse.
December 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29095782/a-rare-case-of-infantile-myofibromatosis-presenting-to-the-emergency-department-as-undiagnosed-long-bone-fractures
#12
Melissa A McGuire, Phyllis L Hendry, Nancy Hong
Infantile myofibromatosis is a disorder of mesenchymal tumors that usually presents within the first 2 years of life. Most patients initially present because of the presence of visible or palpable subcutaneous tumors. We report a case of a fussy 5-week-old infant who presented to an emergency department with bilateral femur fractures initially thought to be due to nonaccidental trauma or a metabolic bone disorder. She was ultimately diagnosed after admission with infantile myofibromatosis after taking an extensive family history and after further laboratory and radiologic evaluation...
November 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29068874/prevalence-of-nonaccidental-trauma-among-children-at-american-college-of-surgeons-verified-pediatric-trauma-centers
#13
David D A Bogumil, Natalie E Demeter, Karen Kay Imagawa, Jeffrey S Upperman, Rita V Burke
BACKGROUND: Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting. Extreme cases of child abuse, or nonaccidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians who have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma verification...
November 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28926487/the-frequency-of-nonaccidental-trauma-in-children-under-the-age-of-3-years-with-femur-fractures-is-there-a-better-cutoff-point-for-universal-workups
#14
Jochen P Son-Hing, Z Deniz Olgun
The purpose of this study was to evaluate narrower age groups in children aged 0-4 years to determine whether guidelines should be refined when investigating femur fractures for nonaccidental trauma (NAT). This was a retrospective review of the pediatric trauma database at our level 1 pediatric trauma center. The database was examined from 2009 to present. We examined rates of NAT in the less than or equal to 12-month, 13-24-month, 25-36-month, and 37-48-month age groups. χ was used to compare rates of NAT between these groups, and P less than 0...
September 18, 2017: Journal of Pediatric Orthopedics. Part B
https://www.readbyqxmd.com/read/28885391/abusive-injuries-are-worse-than-vehicular-injuries-should-we-refocus-prevention
#15
Brian D Robertson, Marisa Abbe, Jamie Pelletier, Halim Hennes
OBJECTIVES: The objective of this study was to compare the injury severity and outcome of motor vehicle and nonaccidental traumatic injuries and examine trends in mortality rates over time. METHODS: We reviewed data from 2005 to 2013 from a level 1 pediatric trauma center including demographics, injury severity, and outcomes. Primary outcomes of interest were mortality rates and hospital length of stay. RESULTS: Injury severity scores were significantly worse for nonaccidental traumas (NATs) (P < 0...
September 5, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28665242/changes-in-use-of-cervical-spine-magnetic-resonance-imaging-for-pediatric-patients-with-nonaccidental-trauma
#16
Ahyuda Oh, Michael Sawvel, David Heaner, Amina Bhatia, Andrew Reisner, R Shane Tubbs, Joshua J Chern
OBJECTIVE Past studies have suggested correlations between abusive head trauma and concurrent cervical spine (c-spine) injury. Accordingly, c-spine MRI (cMRI) has been increasingly used in radiographic assessments. This study aimed to determine trends in cMRI use and treatment, and outcomes related to c-spine injury in children with nonaccidental trauma (NAT). METHODS A total of 503 patients with NAT who were treated between 2009 and 2014 at a single pediatric health care system were identified from a prospectively maintained database...
September 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28541857/a-multidisciplinary-child-protection-team-improves-the-care-of-nonaccidental-trauma-patients
#17
John M Draus
We initiated a multidisciplinary Child Protection Team (CPT) as a subgroup of our pediatric multidisciplinary trauma peer review committee. Meetings are held monthly. Nonaccidental trauma (NAT) patients from the preceding month are reviewed. The meeting has two parts. During the open part, detectives and child protective services (CPS) workers are invited to discuss specific cases. The closed part focuses on improvement of specific processes and future outcomes. Attendance is recorded and minutes are kept. We sought to review accomplishments of this group...
May 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28520688/the-association-of-nonaccidental-trauma-with-historical-factors-examination-findings-and-diagnostic-testing-during-the-initial-trauma-evaluation
#18
Mauricio A Escobar, Katherine T Flynn-OʼBrien, Marc Auerbach, Gunjan Tiyyagura, Matthew A Borgman, Susan J Duffy, Kelly S Falcone, Rita V Burke, John M Cox, Sabine A Maguire
No abstract text is available yet for this article.
June 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28325786/impact-on-hospital-resources-of-systematic-evaluation-and-management-of-suspected-nonaccidental-trauma-in-patients-less-than-4-years-of-age
#19
Bethann M Pflugeisen, Mauricio A Escobar, Dustin Haferbecker, Yolanda Duralde, Elizabeth Pohlson
OBJECTIVE: There has been an increasing movement worldwide to create systematic screening and management procedures for atypical injury patterns in children with the hope of better detecting and evaluating nonaccidental trauma (NAT). A legitimate concern for any hospital considering implementation of a systematic evaluation process is the impact on already burdened hospital resources. We hypothesized that implementation of a guideline that uses red flags related to history, physical, or radiologic findings to trigger a standardized NAT evaluation of patients <4 years would not negatively affect resource utilization at our level II pediatric trauma center...
April 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28318055/menkes-disease-mimicking-child-abuse
#20
Rebecca J Droms, Jillian F Rork, Riley McLean, Madelena Martin, Leah Belazarian, Karen Wiss
Althouygh Menkes disease has well-recognized neurologic, developmental, and cutaneous features, the initial presentation may resemble child abuse. We describe a 5-month-old boy with multiple fractures indicative of nonaccidental trauma who was ultimately diagnosed with Menkes disease. Copper deficiency leads to connective tissue abnormalities and may result in subdural hematomas, wormian bones, cervical spine defects, rib fractures, and spurring of the long bone metaphyses. Several of these findings, including fractures and subdural hematomas, may be misinterpreted as child abuse...
May 2017: Pediatric Dermatology
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