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Nonaccidental trauma

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https://www.readbyqxmd.com/read/29244703/the-risk-of-assuming-abuse-in-an-infant-with-an-isolated-metaphyseal-lesion-a-case-report
#1
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
#2
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
#3
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...
December 6, 2017: Pediatrics
https://www.readbyqxmd.com/read/29153813/surgical-stabilization-of-rib-fractures-in-a-6-year-old-child-after-blunt-trauma
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
https://www.readbyqxmd.com/read/28302360/consistent-screening-of-admitted-infants-with-head-injuries-reveals-high-rate-of-nonaccidental-trauma
#14
Paul T Kim, Jillian McCagg, Ashley Dundon, Zach Ziesler, Suzanne Moody, Richard A Falcone
PURPOSE: Implementation of a nonaccidental trauma (NAT) screening guideline for the evaluation of infants admitted with an unwitnessed head injury has eliminated screening disparities. This study sought to determine the overall NAT rate and key predictive factors using this guideline. METHODS: All infants screened via the guideline from 2008 to 2015 were retrospectively reviewed. The overall rate of NAT as determined by our child abuse team was determined. In addition, a logistic regression model was developed to evaluate potential predictors of increased risk of NAT...
November 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28245144/cns-injuries-in-abusive-head-trauma
#15
REVIEW
Jason N Wright
OBJECTIVE: Abusive head trauma (AHT) is one of the most common subtypes of nonaccidental trauma and is a leading cause of traumatic brain injury in young children. Imaging plays a crucial role in the evaluation of children with suspected AHT and can aid in accurate diagnosis because clinical presentation may be nonspecific. In this article, the CNS injuries that are characteristic of AHT are reviewed with an emphasis on pathophysiology and imaging appearance. CONCLUSION: AHT is a frequent cause of neurologic injury in children, particularly in infants in the first year of life...
May 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28186860/traumatic-rib-injury-patterns-imaging-pitfalls-complications-and-treatment
#16
REVIEW
Brett S Talbot, Christopher P Gange, Apeksha Chaturvedi, Nina Klionsky, Susan K Hobbs, Abhishek Chaturvedi
The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures...
March 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28103120/compassionate-options-for-pediatric-ems-cope-addressing-communication-skills
#17
Aaron W Calhoun, Erica R H Sutton, Anita P Barbee, Beth McClure, Carrie Bohnert, Richard Forest, Peter Taillac, Mary E Fallat
INTRODUCTION: Each year, 16,000 children suffer cardiopulmonary arrest, and in one urban study, 2% of pediatric EMS calls were attributed to pediatric arrests. This indicates a need for enhanced educational options for prehospital providers that address how to communicate to families in these difficult situations. In response, our team developed a cellular phone digital application (app) designed to assist EMS providers in self-debriefing these events, thereby improving their communication skills...
May 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28059971/geographical-information-system-evaluation-and-trends-of-nonaccidental-trauma-at-a-level-i-trauma-center-pilot-study
#18
Michael Robert Smith, Robert Lee Davis, Patricia Anne Phillips, Tatyana Shvilkina, Kamalijit Kaur, Heather Katrina Tabolt, Matthew Krause, Vincent Galdi
PREMISE: Although trauma may be considered a random act, geographical patterns of trauma potentially emerge. Our institution is unique in that it rests at an intersection of two of the highest areas of poverty and assault in New York City and has adequate data to analyze these patterns. METHODS: We review the incident reports logged by emergency medical services (EMS) technicians arriving with intentionally injured trauma patients from January 1 to December 31, 2013 at a single institution...
February 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28050641/children-presenting-in-delayed-fashion-after-minor-head-trauma-with-scalp-swelling-do-they-require-further-workup
#19
Jonathan N Sellin, Amee Moreno, Sheila L Ryan, Sandi K Lam, Marcella Donaruma-Kwoh, Thomas G Luerssen, Andrew Jea
PURPOSE: It is common to evaluate children who have sustained minor head trauma with computed tomography (CT) of the head. Scalp swelling, in particular, has been associated with intracranial injury. A subset of patients, however, present in delayed fashion, often days after the head trauma, as soft tissue edema progresses and their caregiver notices scalp swelling. We explore the value of further workup in this setting. METHODS: We conducted a retrospective review of a prospectively collected cohort of children ≤24 months of age presenting to the Texas Children's Hospital with scalp swelling more than 24 h following a head trauma...
April 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/27918377/utility-of-emergency-department-observation-units-for-neurologically-intact-children-with-head-ct-abnormalities-secondary-to-acute-closed-head-injury
#20
Roxanna Lefort, Jill V Hunter, Andrea T Cruz, A Chantal Caviness, Thomas G Luerssen, Aderonke Adekunle-Ojo
OBJECTIVE: The aim of the study was to evaluate the utility of the emergency department observation unit (EDOU) for neurologically intact children with closed head injuries (CHIs) and computed tomography (CT) abnormalities. METHODS: A retrospective cohort study of children aged 0 to 18 years with acute CHI, abnormal head CT, and a Glasgow Coma Scales score of 14 or higher admitted to the EDOU of a tertiary care children's hospital from 2007 to 2010. Children with multisystem trauma, nonaccidental trauma, and previous neurosurgical or coagulopathic conditions were excluded...
March 2017: Pediatric Emergency Care
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