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Duodenal injuries in the very young: child abuse?

Lauren Sowrey1, Karla A Lawson, Pamela Garcia-Filion

  • 1Trauma Services, Dell Children's Medical Center of Central Texas, Department of Surgery University of Texas Southwestern Medical School, Austin, Texas, USA.

The Journal of Trauma and Acute Care Surgery
|December 29, 2012
PubMed

Insights

Child abuse is strongly linked to duodenal injuries in young children, especially those under two years old. This finding supports mandatory abuse investigations for duodenal injuries in this age group.

Area of Science:

  • Pediatric Trauma Surgery
  • Child Abuse Pediatrics
  • Gastrointestinal Injury Research

Background:

  • Duodenal injuries in children are rare but have been linked to child abuse in case reports.
  • Few studies have examined the association between duodenal injuries and their mechanism in very young children.
  • This study hypothesizes a significant association between duodenal injuries and child abuse in the very young.

Purpose of the Study:

  • To investigate the association between duodenal injuries and their mechanism in children aged 0–5 years.
  • To determine the prevalence of child abuse in pediatric duodenal injury cases.
  • To identify risk factors and outcomes associated with duodenal injuries in young children.

Main Methods:

  • Retrospective cohort study of patients aged 0–5 years with duodenal injuries admitted to six Level I pediatric trauma centers (1991–2011).
  • Data collected included age, mechanism of injury, injury type, associated injuries, mortality, and abuse investigation results.
  • Statistical analysis using Fischer's exact test to determine relationships between variables.

Main Results:

  • 32 patients with duodenal injuries were identified (mean age 3 years); 56% involved perforations/transections and 44% hematomas.
  • Child abuse accounted for 62.5% of duodenal injuries (20 of 32 cases).
  • All duodenal injuries in children under 2 years were attributed to child abuse (6 of 6), with a significant increase in abuse-related injuries over the study period.

Conclusions:

  • Duodenal injuries are rare in pediatric patients.
  • Child abuse is consistently associated with duodenal injuries in children younger than 2 years.
  • A child abuse investigation is warranted for all children under 2 years presenting with duodenal injury.
Abstract

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