Child homicide: emergency department recognition

Homicide is escalating as a cause of sudden death in childhood. With the ever-rising rate of child abuse in the United States, the emergency physician is increasingly likely to encounter cases of attempted homicide. In order to improve survival in such cases, the emergency department (ED) staff must be alert to the subtle signs and symptoms of this form of trauma and be prepared to institute life-saving therapy. We reviewed 12 cases of child homicide seen in our ED between 1981 and 1983 and summarized the findings on these unfortunate children. The typical victim was a young child in the second half of the first year or in the second year of life. The most common forms of fatal injury were CNS injury and abdominal trauma. In both types of injuries, there were often subtle findings on external physical examination. It was important for the physician to have a high index of suspicion based on a protean chief complaint, a lack of preceding history of illness, the time of presentation to the ED, and more subtle physical findings such as minor skin bruising, retinal hemorrhage, and distended abdomen. A low hematocrit was also suggestive of traumatic cause for the child's critical state. In addition, autopsy findings for the 12 patients are presented.