Child homicide: emergency department recognition

Area of Science:

• Pediatric Emergency Medicine
• Forensic Pathology
• Child Abuse and Neglect

Background:

• Homicide is an increasing cause of sudden childhood death.
• Child abuse rates are rising, leading to more emergency department encounters for attempted homicide.
• Emergency department staff must recognize subtle trauma signs to improve survival.

Purpose of the Study:

• To review cases of child homicide treated in an emergency department.
• To identify common injury patterns and subtle clinical indicators.
• To emphasize the importance of a high index of suspicion for pediatric trauma.

Main Methods:

• Retrospective review of 12 child homicide cases from 1981-1983.
• Analysis of clinical presentations, physical examination findings, and laboratory results.
• Inclusion of autopsy findings for all patients.

Main Results:

• Typical victims were young children (6-24 months).
• Common fatal injuries included central nervous system (CNS) injury and abdominal trauma.
• Subtle external findings (bruising, retinal hemorrhage, abdominal distension) and low hematocrit were suggestive of trauma.

Conclusions:

• Emergency physicians must maintain a high index of suspicion for homicide in critically ill children.
• Subtle physical findings, protean chief complaints, and lack of history warrant thorough investigation.
• Prompt recognition and intervention are vital for improving outcomes in pediatric trauma cases.