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Additional injuries in young infants with concern for abuse and apparently isolated bruises
Nancy S Harper1, Kenneth W Feldman2, Naomi F Sugar3
1Children's Physician Services of South Texas, Driscoll Children's Hospital, Corpus Christi, TX.
Insights
Young infants with bruises evaluated for abuse often have additional serious injuries. Medical evaluations should include skeletal surveys, neuroimaging, and abdominal screening to detect these injuries.
Area of Science:
- Pediatrics
- Child Abuse Pediatrics
- Forensic Pediatrics
Background:
- Bruising in infants can be a sign of physical abuse.
- Young infants (<6 months) with bruising require thorough evaluation for potential abuse and associated injuries.
Purpose of the Study:
- To determine the prevalence of additional injuries or bleeding disorders in young infants evaluated for abuse due to bruising.
- To inform diagnostic protocols for infants presenting with bruises.
Main Methods:
- Secondary analysis of an observational study involving 20 US child abuse teams.
- Included infants <6 months with apparently isolated bruising undergoing diagnostic testing.
- Evaluated for additional injuries via skeletal surveys, neuroimaging, and abdominal screening.
Main Results:
- Of 254 infants with bruises, 57.5% had apparently isolated bruises.
- 50% of these infants had at least one additional serious injury identified.
- No bleeding disorders were identified, but 50% had a high perceived likelihood of abuse.
Conclusions:
- Infants <6 months with bruising and suspected abuse face a high risk of additional serious injuries.
- Routine evaluation should include physical examination, skeletal survey, neuroimaging, and abdominal screening.
- Early and comprehensive diagnostic testing is crucial for accurate assessment.
Objective:
To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising.
Study Design:
This was a prospectively planned secondary analysis of an observational study of children<10 years (120 months) of age evaluated for possible physical abuse by 20 US child abuse teams. This analysis included infants<6 months of age with apparently isolated bruising who underwent diagnostic testing for additional injuries or bleeding disorders.
Results:
Among 2890 children, 33.9% (980/2890) were <6 months old, and 25.9% (254/980) of these had bruises identified. Within this group, 57.5% (146/254) had apparently isolated bruises at presentation. Skeletal surveys identified new injury in 23.3% (34/146), neuroimaging identified new injury in 27.4% (40/146), and abdominal injury was identified in 2.7% (4/146). Overall, 50% (73/146) had at least one additional serious injury. Although testing for bleeding disorders was performed in 70.5% (103/146), no bleeding disorders were identified. Ultimately, 50% (73/146) had a high perceived likelihood of abuse.
Conclusions:
Infants younger than 6 months of age with bruising prompting subspecialty consultation for abuse have a high risk of additional serious injuries. Routine medical evaluation for young infants with bruises and concern for physical abuse should include physical examination, skeletal survey, neuroimaging, and abdominal injury screening.