Abstract
Non-accidental trauma (NAT) represents a significant cause of morbidity and mortality in the pediatric population. The management of these patients often involves many care providers including the surgeon. Victims of NAT often present with multiple injuries and as such should be treated as trauma patients with complete trauma evaluation including primary, secondary and tertiary surveys. Common injury patterns in NAT include extremity fractures, closed head injury and intra-abdominal injury. Brain imaging is of importance to rule out acute or sub-acute intracranial hemorrhage. Children under the age of 5 years with acute intracranial pathology should also be evaluated by an ophthalmologist to rule out retinal hemorrhages, which are considered pathognomonic for child abuse from violent shaking. In instances when abdominal injury is suspected, prompt evaluation by a surgeon is recommended along with CT imaging. Finding of extremity fractures should prompt evaluation by an orthopedic surgeon. At our institution, all patients with suspected NAT are admitted to the pediatric surgery service for complete evaluation and management. We encourage other pediatric trauma centers to employ a similar approach so that these complicated patients are managed safely and effectively.
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References
Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK (1962) The battered-child syndrome. Jama 181:17–24
Glick JC, Staley K (2007) Inflicted traumatic brain injury: advances in evaluation and collaborative diagnosis. Pediatr Neurosurg 43(5):436–441. doi:10.1159/000106400
Lane WG, Dubowitz H, Langenberg P, Dischinger P (2012) Epidemiology of abusive abdominal trauma hospitalizations in United States children. Child Abuse Negl 36(2):142–148. doi:10.1016/j.chiabu.2011.09.010
Trokel M, Discala C, Terrin NC, Sege RD (2006) Patient and injury characteristics in abusive abdominal injuries. Pediatr Emerg Care 22(10):700–704. doi:10.1097/01.pec.0000238734.76413.d0
Maguire SA, Upadhyaya M, Evans A, Mann MK, Haroon MM, Tempest V, Lumb RC, Kemp AM (2013) A systematic review of abusive visceral injuries in childhood—their range and recognition. Child Abuse Negl 37(7):430–445. doi:10.1016/j.chiabu.2012.10.009
Sowrey L, Lawson KA, Garcia-Filion P, Notrica D, Tuggle D, Eubanks JW 3rd, Maxson RT, Recicar J, Megison SM, Garcia NM (2013) Duodenal injuries in the very young: child abuse? J Trauma Acute Care Surg 74(1):136–141. doi:10.1097/TA.0b013e3182788cb2 (discussion 141–132)
(2009) Diagnostic imaging of child abuse. Pediatrics. 123(5):1430–1435. doi:10.1542/peds.2009-0558
Lindberg DM, Shapiro RA, Blood EA, Steiner RD, Berger RP (2013) Utility of hepatic transaminases in children with concern for abuse. Pediatrics 131(2):268–275. doi:10.1542/peds.2012-1952
Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM, Yu C, Kan JH (2011) CT identification of abdominal injuries in abused pre-school-age children. Pediatr Radiol 41(5):643–651. doi:10.1007/s00247-010-1899-9
Larimer EL, Fallon SC, Westfall J, Frost M, Wesson DE, Naik-Mathuria BJ (2013) The importance of surgeon involvement in the evaluation of non-accidental trauma patients. J Pediatr Surg 48(6):1357–1362. doi:10.1016/j.jpedsurg.2013.03.035
Sink EL, Hyman JE, Matheny T, Georgopoulos G, Kleinman P (2011) Child abuse: the role of the orthopaedic surgeon in nonaccidental trauma. Clin Orthop Relat Res 469(3):790–797. doi:10.1007/s11999-010-1610-3
Flaherty EG, Perez-Rossello JM, Levine MA, Hennrikus WL (2014) Evaluating children with fractures for child physical abuse. Pediatrics 133(2):e477–e489. doi:10.1542/peds.2013-3793
Parks SE, Kegler SR, Annest JL, Mercy JA (2012) Characteristics of fatal abusive head trauma among children in the USA: 2003–2007: an application of the CDC operational case definition to national vital statistics data. Inj Prev 18(3):193–199. doi:10.1136/injuryprev-2011-040128
Barlow K, Thompson E, Johnson D, Minns RA (2004) The neurological outcome of non-accidental head injury. Pediatr Rehabil 7(3):195–203. doi:10.1080/13638490410001715331
Merten DF, Osborne DR, Radkowski MA, Leonidas JC (1984) Craniocerebral trauma in the child abuse syndrome: radiological observations. Pediatr Radiol 14(5):272–277
Katz JS, Oluigbo CO, Wilkinson CC, McNatt S, Handler MH (2010) Prevalence of cervical spine injury in infants with head trauma. J Neurosurg Pediatr 5(5):470–473. doi:10.3171/2009.11.peds09291
Kadom N, Khademian Z, Vezina G, Shalaby-Rana E, Rice A, Hinds T (2014) Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. Pediatr Radiol 44(7):839–848. doi:10.1007/s00247-014-2874-7
Levin AV, Christian CW (2010) The eye examination in the evaluation of child abuse. Pediatrics 126(2):376–380. doi:10.1542/peds.2010-1397
Gole G (2010) Retinal haemorrhages in infants, abusive head trauma and the ophthalmologist. Clin Experiment Ophthalmol 38(5):435–436. doi:10.1111/j.1442-9071.2010.02339.x
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Naik-Mathuria, B., Akinkuotu, A. & Wesson, D. Role of the surgeon in non-accidental trauma. Pediatr Surg Int 31, 605–610 (2015). https://doi.org/10.1007/s00383-015-3688-x
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DOI: https://doi.org/10.1007/s00383-015-3688-x