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Inadequate sociomedical evaluation of possible abusive head trauma in Yokohama
Atsuo Sato1,2, Nobuyuki Kikuchi1,3, Shumpei Yokota1,4
1Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Kanagawa, Japan.
Insights
Sociomedical evaluations for suspected abusive head trauma in Yokohama are inadequate. Many infant intracranial hemorrhage cases lacked thorough examinations and reporting to child protection services.
Area of Science:
- Pediatrics
- Forensic Medicine
- Public Health
Background:
- No prior studies assessed combined evaluations for abusive head trauma in Japan.
- Focus on Yokohama's local districts for child protection adequacy.
Purpose of the Study:
- Evaluate the adequacy of combined assessments for abusive head trauma.
- Examine reporting practices to child protection services.
Main Methods:
- Questionnaire survey of hospitalized patients under 24 months with intracranial hemorrhage (ICH).
- Data collected from 11 large hospitals in Yokohama, Japan (2011-2013).
Main Results:
- 51 ICH patients identified; 84% under 12 months.
- Subdural hematoma was the most common diagnosis (51%).
- Significant gaps in examinations (skin lesions, skeletal surveys, funduscopy) and reporting to child protection teams and services.
Conclusions:
- Sociomedical evaluation of suspected child abuse is systematically inadequate in Yokohama.
- Urgent need for improved inter-agency collaboration and standardized protocols.
Background:
There have been no previous studies on the adequacy of combined evaluation of possible abusive head trauma cases by frontline medical personnel, hospital-based child protection teams, and child protective services in local districts of Japan.
Methods:
We conducted a questionnaire survey of hospitalized patients under 24 months old with a diagnosis of intracranial hemorrhage (ICH) from January 2011 to December 2013. Eleven large-scale general hospitals in Yokohama, Japan were surveyed, which provide centralized inpatient care to moderately-severely ill children.
Results:
A total of 51 ICH patients were listed from eight hospitals. Median patient age was 7 months, and 84% were younger than 12 months. The most common diagnosis on computed tomography was subdural hematoma (n = 26; 51%). Of a total of 51 cases, 31 (61%) occurred inside the home; the injury scene was unknown in six cases (12%). We reviewed these 37 cases from the viewpoint of evaluation with concern for suspected child abuse. Three out of 37 patients (8%) were not examined for inflicted skin lesions, and skeletal surveys and funduscopy were not conducted in 14 (38%) and 15 (41%), respectively. Thirteen out of 37 cases (35%) were not reported to hospital-based child protection teams and 22 (59%) were not reported to regional child protective services.
Conclusion:
The sociomedical evaluation of possible child abuse appears to be systematically inadequate in Yokohama.
