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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Sentinel injuries in infants evaluated for child physical abuse
Lynn K Sheets1, Matthew E Leach, Ian J Koszewski
1Medical College of Wisconsin, Milwaukee, Wisconsin, USA. lsheets@chw.org
Insights
Previous sentinel injuries are common in abused infants, with over 27% experiencing them before severe physical abuse. Early detection of these warning signs in infants can help prevent severe abuse.
Area of Science:
- Pediatrics
- Child Abuse Prevention
- Forensic Medicine
Background:
- Minor abusive injuries can precede severe physical abuse in infants.
- Identifying early warning signs is crucial for intervention.
Purpose of the Study:
- To determine the frequency of sentinel injuries in abused infants compared to non-abused infants.
- To assess the potential of sentinel injuries as predictors of severe abuse.
Main Methods:
- Retrospective case-control study of 401 infants under 12 months old evaluated for abuse.
- Defined sentinel injury as a suspicious prior injury with an implausible explanation.
- Compared incidence of sentinel injuries between definitely abused, intermediate concern, and non-abused groups.
Main Results:
- 27.5% of definitely abused infants had sentinel injuries versus 8% with intermediate concern (OR 4.4).
- No non-abused infants had sentinel injuries.
- Sentinel injuries were primarily bruising (80%) and occurred early in infancy (66% <3 months).
Conclusions:
- Sentinel injuries are significantly more common in abused infants.
- Early identification and intervention for sentinel injuries may prevent severe physical abuse.
- Medical providers were aware of sentinel injuries in less than half of cases.
Objective:
Relatively minor abusive injuries can precede severe physical abuse in infants. Our objective was to determine how often abused infants have a previous history of "sentinel" injuries, compared with infants who were not abused.
Methods:
Case-control, retrospective study of 401, <12-month-old infants evaluated for abuse in a hospital-based setting and found to have definite, intermediate concern for, or no abuse after evaluation by the hospital-based Child Protection Team. A sentinel injury was defined as a previous injury reported in the medical history that was suspicious for abuse because the infant could not cruise, or the explanation was implausible.
Results:
Of the 200 definitely abused infants, 27.5% had a previous sentinel injury compared with 8% of the 100 infants with intermediate concern for abuse (odds ratio: 4.4, 95% confidence interval: 2.0-9.6; P < .001). None of the 101 nonabused infants (controls) had a previous sentinel injury (P < .001). The type of sentinel injury in the definitely abused cohort was bruising (80%), intraoral injury (11%), and other injury (7%). Sentinel injuries occurred in early infancy: 66% at <3 months of age and 95% at or before the age of 7 months. Medical providers were reportedly aware of the sentinel injury in 41.9% of cases.
Conclusions:
Previous sentinel injuries are common in infants with severe physical abuse and rare in infants evaluated for abuse and found to not be abused. Detection of sentinel injuries with appropriate interventions could prevent many cases of abuse.
