Identification and Characterization of Oral Injury in Suspected Child Abuse Cases: One Health System's Experience
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Published on: December 31, 2017
Caroline L S George1, Samuel S N Theesfeld1, Qi Wang2
1From the Department of Pediatrics, University of Minnesota, University of Minnesota Masonic Children's Hospital.
Insights
Differentiating inflicted vs. accidental oral injuries in young children is crucial. Suspected child abuse (SCA) cases were younger, less mobile, and more likely to have tongue or oropharynx injuries than accidental injuries.
Area of Science:
- Pediatric medicine
- Forensic medicine
- Child abuse research
Background:
- Distinguishing inflicted from accidental injuries in young children is critical for timely intervention.
- Clinical tools for identifying inflicted oral injuries are lacking.
- Oral injuries are often overlooked in child abuse evaluations.
Purpose of the Study:
- To identify characteristics differentiating inflicted from accidental oral injuries in children under 24 months.
- To inform the development of a clinical tool for diagnosing child physical abuse.
Main Methods:
- Retrospective review of medical records and billing codes (ICD-9) for children under 24 months (2004-2014).
- Comparison of patient demographics, trauma history, and oral injury characteristics between accidental injury and suspected child abuse (SCA) groups.
- Statistical analysis to identify significant differences between the groups.
Main Results:
- Suspected child abuse (SCA) patients were younger and less mobile than those with accidental injuries.
- Tongue injuries and oropharyngeal bruising were significantly more common in the SCA group.
- Lacerations were less frequent, and a history of trauma was less likely in the SCA group.
Conclusions:
- Significant differences exist in patient characteristics, trauma history, and injury patterns between inflicted and accidental oral injuries.
- A future clinical tool incorporating age, trauma history, tongue injury, and oropharyngeal bruising could aid in diagnosing child physical abuse.
- These findings highlight the importance of a thorough oral examination in evaluating young children with suspected abuse.
Objectives:
Accurately differentiating inflicted from accidental injury in infants and toddlers is critical. Many studies have documented characteristics of inflicted bruises, fractures, and head injuries facilitating the development of clinical tools. There are few studies characterizing inflicted oral injuries, and no clinical tools exist. This study identified characteristics that differentiated inflicted from accidental oral injuries in children younger than 24 months.
Methods:
Retrospective review using International Classification of Diseases, Ninth Revision billing codes and an internal clinical database tool identified children younger than 24 months between 2004 and 2014. Two groups were created according to the presence or absence of a child abuse diagnosis resulting in an accidental injury and suspected child abuse (SCA) group. Statistical analyses were performed on patient demographics, history of trauma, oral injury characterization, bruises, and fractures.
Results:
Billing codes were applied differently between the accidental injury and SCA groups, even when the same injury was described. Patients with SCA were younger and less mobile when compared with those with accidental injuries (P < 0.0001). Tongue injuries (P < 0.0001) and oropharynx bruising (P = 0.0018) were observed more and lacerations were observed less (P < 0.0001) in the SCA group. The SCA group was less likely to have a trauma history than those with accidental injury (P < 0.0001).
Conclusions:
Several differences in patient characteristics, trauma history, injury type, and location were identified between the accidental versus SCA groups. A future clinical tool that incorporates age, history of trauma on presentation, tongue injury, and oropharynx bruising may assist medical providers in placing child physical abuse in the differential diagnosis.
