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Morikone A, Mouesca JP. Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse. ARCH ARGENT PEDIATR 2024; 122:e202310139. [PMID: 38197589 DOI: 10.5546/aap.2023-10139.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.
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Affiliation(s)
- Alicia Morikone
- Unit of Family Violence, Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - Juan Pablo Mouesca
- Unit of Family Violence, Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
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2
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McGuire A, Gabrielli J, Jackson Y. Trying to Fit a Square Peg in a Round Hole? Testing the Robustness of Maltreatment Measurement Models for Youth. Child Maltreat 2024; 29:233-245. [PMID: 36592333 DOI: 10.1177/10775595221149447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Research on maltreatment exposure often demonstrates mixed findings and a potential explanation for this may be the measurement of maltreatment. One approach for addressing measurement concerns, which also accounts for maltreatment's multidimensional nature, is the use of a measurement or latent model. However, there is minimal evidence on the generalizability of this approach across populations of youth. This study examined measurement invariance of a one-factor maltreatment model across two samples of youth exposed to maltreatment using case file data from the SPARK and LONGSCAN datasets (N = 1286). Results showed that only partial metric invariance could be established for the one-factor model between SPARK and LONGSCAN subsamples, and neglect and emotional abuse indicators tended to show low factor loadings. Findings highlight the need to consider how potential differences in documentation and maltreatment rates influence model performance and the need for research on which maltreatment characteristics may best capture youths' experiences.
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Affiliation(s)
- Austen McGuire
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Joy Gabrielli
- Department of Clinical and Health Psychology, University of Florida Health, Gainesville, FL, USA
| | - Yo Jackson
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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3
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Håkstad K, Fegran L, Hovden E, Köpp UMS. Orofacial signs of child or adolescent maltreatment identified by dentists and dental hygienists: A scoping review. Int J Paediatr Dent 2024; 34:285-301. [PMID: 38050876 DOI: 10.1111/ipd.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Child maltreatment, the abuse or neglect of children aged 0-18 years, is a severe and underreported global problem. Compared with other body parts, the orofacial region displays more signs of child maltreatment. Dentists and dental hygienists are therefore well situated to identify orofacial signs of child maltreatment. AIM To map the current literature on orofacial signs of child maltreatment identified by dentists or dental hygienists. DESIGN A scoping review was conducted based on systematic searches of Medline (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) for primary qualitative and quantitative studies through June 6, 2022. RESULTS Twenty-nine studies were included in this scoping review. Though all child maltreatment types were identified in dental settings, physical abuse and dental neglect were most commonly identified. Reports of caries dominated the orofacial signs, followed by bruises (intra- and extraoral), poor oral hygiene, dental trauma, and lacerations (intra- and extraoral). Case reports were used most commonly to describe orofacial signs of child maltreatment. CONCLUSION Dental clinicians identify orofacial signs of all child maltreatment types intraorally. Dentists identify the same extraoral signs as do other healthcare professionals, with bruising being the most common.
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Affiliation(s)
- Katrine Håkstad
- Department of Health- and Sport Science, University of Agder, Kristiansand, Norway
- Agder County Municipality, Public Dental Service, Kristiansand, Norway
| | - Liv Fegran
- Department of Health- and Sport Science, University of Agder, Kristiansand, Norway
- Department of Peadiatrics, Sørlandet Hospital HF, Kristiansand, Norway
| | - Ewa Hovden
- The Oral Health Centre of Expertise in East of (TkØ), Kristiansand, Norway
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Joskowitz K, Patwardhan UM, Floan GM, Heflinger M, Cruz S, David M, Jadhav P, Nienow S, Thangarajah H, Ignacio RC. Evaluating Outcomes of Nonaccidental Trauma in Military Children. J Am Coll Surg 2024; 238:801-807. [PMID: 38372360 DOI: 10.1097/xcs.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Nonaccidental trauma (NAT), or child abuse, is a leading cause of childhood injury and death in the US. Studies demonstrate that military-affiliated individuals are at greater risk of mental health complication and family violence, including child maltreatment. There is limited information about the outcomes of military children who experience NAT. This study compares the outcomes between military-dependent and civilian children diagnosed with NAT. STUDY DESIGN A single-institution, retrospective review of children admitted with confirmed NAT at a Level I trauma center was performed. Data were collected from the institutional trauma registry and the Child Abuse Team's database. Military affiliation was identified using insurance status and parental or caregiver self-reported active-duty status. Demographic and clinical data including hospital length of stay (LOS), morbidity, specialty consult, and mortality were compared. RESULTS Among 535 patients, 11.8% (n = 63) were military-affiliated. The median age of military-associated patients, 3 months (interquartile range [IQR] 1 to 7), was significantly younger than civilian patients, 7 months (IQR 3 to 18, p < 0.001). Military-affilif:ated patients had a longer LOS of 4 days (IQR 2 to 11) vs 2 days (IQR 1 to 7, p = 0.041), increased morbidity or complication (3 vs 2 counts, p = 0.002), and a higher mortality rate (10% vs 4%, p = 0.048). No significant difference was observed in the number of consults or injuries, trauma activation, or need for surgery. CONCLUSIONS Military-affiliated children diagnosed with NAT experience more adverse outcomes than civilian patients. Increased LOS, morbidity or complication, and mortality suggest military-affiliated patients experience more life-threatening NAT at a younger age. Larger studies are required to further examine this population and better support at-risk families.
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Affiliation(s)
- Katie Joskowitz
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Utsav M Patwardhan
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA (Patwardhan, Floan)
| | - Gretchen M Floan
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA (Patwardhan, Floan)
| | - Megan Heflinger
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Sheena Cruz
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Maya David
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Priyanka Jadhav
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Shalon Nienow
- Division of Child Abuse Pediatrics, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA (Nienow)
- Division of Child Abuse Pediatrics, Rady Children's Hospital-San Diego, San Diego, CA (Nienow)
- Chadwick Center for Children and Families at Rady Childrens Hospital, San Diego, CA (Nienow)
| | - Hari Thangarajah
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA (Thangarajah, Ignacio)
| | - Romeo C Ignacio
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA (Thangarajah, Ignacio)
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Jude G, Slingsby B, Cassese JA, Schroeder C, Moore J, Barron C. Efficacy of Child Abuse Evaluations for Infants With Possible Subdural Hemorrhage Identified on Cranial Ultrasound Completed for Macrocephaly. Clin Pediatr (Phila) 2024; 63:506-511. [PMID: 37350029 DOI: 10.1177/00099228231182780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Abusive head trauma (AHT) is a significant cause of morbidity and mortality for infants. Determining when to pursue a complete physical abuse evaluation can be difficult, especially for nonspecific findings or when a child appears clinically well. This retrospective study of 7 cases sought to describe the presentation, evaluation, and diagnoses for infants with abnormal subdural collections identified on cranial ultrasound for macrocephaly, and to determine how frequently AHT is diagnosed. The results of this study showed that while each patient presented due to asymptomatic macrocephaly, the extent of the workup varied greatly. In addition, no infants had suspicious injuries for abuse during the initial evaluation or the year following. In summary, among the 7 patients seen for asymptomatic macrocephaly with possible subdural hemorrhage, there were very inconsistent child abuse workups. There needs to be a standardized clinical guideline for this specific patient population involving a child abuse pediatric evaluation.
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Affiliation(s)
- Gabrielle Jude
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brett Slingsby
- Department of Pediatrics, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - John A Cassese
- Department of Pediatrics, The Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Jessica Moore
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Christine Barron
- Department of Pediatrics, The Warren Alpert Medical School, Brown University, Providence, RI, USA
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Simon G, Angyal M, Dérczy K, Heckmann V. [Lessons of an unpunished child abuse]. Orv Hetil 2024; 165:553-559. [PMID: 38583143 DOI: 10.1556/650.2024.33005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/31/2024] [Indexed: 04/09/2024]
Abstract
Magyarországon évente kb. 2000–2500, fizikailag bántalmazott gyermek kerül a
gyermekjóléti szolgálatok látókörébe, a felderítetlen esetek száma azonban ennek
a többszöröse is lehet. A testi sérüléssel vagy súlyos elhanyagolással járó
eseteket gyakran az egészségügyi szolgáltatók látják elsőként, illetve sokszor
egyedüliként. Az egészségügyi dolgozók jelzési hajlandósága kicsi, jelentési
kötelezettségüknek gyakran nem tesznek eleget. Esetbemutatásunkkal – a jelentési
kötelezettség elmulasztásának következményein túl – a jelzés prevenciós
szerepére szeretnénk felhívni a figyelmet. A másfél éves leánygyermeket
nevelőanyja vitte a helyi fogorvosi rendelőbe eszméletlen állapotban, étel
félrenyelésére hivatkozva. A gyermeknél állapotromlást követően újraélesztés
vált szükségessé, azután kórházi felvételre került sor. Ápolása alatt a gyermek
végig agyhalálnak megfelelő állapotban volt. Felvételekor kétoldali homloktáji
és többszörös mellkasi haematomát rögzítettek, a CT-vizsgálat agyödémát,
valamint kétszeres koponyacsonttörést írt le. A gyermek az ápolása 6. napján
elhunyt. Az esetnek a hatóság felé történő jelzése sem a gyermek ellátása során,
sem a halál bekövetkeztekor nem történt meg. A kórboncolás során a két,
különböző keletkezési idejű koponyacsonttörés mellett kemény burok alatti vérzés
igazolódott. Az esetet követően 9 évvel történt meg a bejelentés a hatóság felé.
A nyomozás megállapította, hogy a kislány halálához idegen kezű fejsérülés
vezetett, melyet a nevelőszülők kiskorú fiúgyermeke okozott, aki azonban az
elkövetéskori életkora miatt nem volt büntethető. A nevelőanya tekintetében
felmerülő bűncselekmény az eljárás idejére elévült, így a nevelőanya büntetőjogi
felelősségre vonása is elmaradt. Az eset rávilágít arra, hogy más
szakterületeken is szükséges lenne az igazságügyi orvostani ismeretek erősítése,
a legideálisabb megoldást azonban kétségtelenül a klinikai igazságügyi
orvostannak a hazai klinikai gyakorlatba történő bevezetése jelenthetné. Orv
Hetil. 2024; 165(14): 553–559.
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Affiliation(s)
- Gábor Simon
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Igazságügyi Orvostani Intézet Pécs, Szigeti u. 12., 7624 Magyarország
| | - Miklós Angyal
- 2 Baranya Vármegyei Rendőr-főkapitányság Pécs Magyarország
| | - Katalin Dérczy
- 3 Pécsi Tudományegyetem, Klinikai Központ, Orvosi Képalkotó Klinika Pécs Magyarország
| | - Veronika Heckmann
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Igazságügyi Orvostani Intézet Pécs, Szigeti u. 12., 7624 Magyarország
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Baker M, Campbell S, Patel K, McWilliams K, Williams S. An examination of questioning methods and the influence of child maltreatment on paediatric pain assessments: Perspectives of healthcare providers. J Eval Clin Pract 2024; 30:367-375. [PMID: 38062796 DOI: 10.1111/jep.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 04/18/2024]
Abstract
AIMS AND OBJECTIVES Children with a history of maltreatment have underestimated and undertreated pain; however, it is unknown if healthcare providers consider maltreatment when assessing children's pain. The current study aimed to address this issue by investigating healthcare providers' pain assessment practices, and specifically, their consideration of child maltreatment. METHOD Healthcare providers (N = 100) completed a survey, asking them to reflect upon their pediatric pain assessment practices (e.g., methods and questions used to assess pain) through self-report and case vignette questions. RESULTS Participants who received continuing education about child maltreatment were more likely to consider maltreatment in several areas of their pediatric pain assessment practice, whereas participants who received continuing education about pediatric pain, were not. Participants were also more likely to report that they would consider maltreatment in vignette responses than in questions regarding their daily practice. CONCLUSION Findings indicate healthcare providers use multidimensional methods when assessing children's pain, although it is unclear when or how they use open-ended vs. option posing questions. Healthcare providers also tended to consider the effects of child maltreatment on children's ability to communicate their pain more so when the history of maltreatment was known to them.
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Affiliation(s)
- Matthew Baker
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Sarah Campbell
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Krupali Patel
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Kelly McWilliams
- Graduate Center and Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, New York, USA
| | - Shanna Williams
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
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Rohrbach JM. [Still room for dispute: on shaken baby syndrome and abusive head trauma (AHT)]. Ophthalmologie 2024; 121:328-330. [PMID: 38443493 DOI: 10.1007/s00347-024-01999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Jens Martin Rohrbach
- Ophthalmopathologisches Labor/Forschungsbereich "Geschichte der Augenheilkunde", Universitäts-Augenklinik Tübingen, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Deutschland.
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D'Alessio AS, Salas Atwell M, Koroukian S, Bailey C, Briggs FBS. Experiences of Adversity and Validity of Baseline Concussion Testing. J Athl Train 2024; 59:373-380. [PMID: 36827602 DOI: 10.4085/1062-6050-0502.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
CONTEXT Neurocognitive testing is a critical tool in the management of sport-related concussions. Adversity during childhood and adolescence affects cognitive tasks, behavioral outcomes, and academic performance. Adversity may be important in baseline concussion test validity as well; however, the influence of these experiences is not well understood. OBJECTIVE To examine the relationship between individual-level experiences of adversity and baseline test validity of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). We hypothesized that experiences of poverty, maltreatment, or extreme neighborhood deprivation would be associated with lower odds of baseline test validity. DESIGN Case-control study. SETTING Cuyahoga County, Ohio. PATIENTS OR OTHER PARTICIPANTS A total of 6495 student-athletes born from 1995 through 2005 who completed a baseline ImPACT test between 10 and 18 years old and were identified in the Child-Household Integrated Longitudinal Data system, a comprehensive data system with demographic and social service usage outcomes for children in Cuyahoga County, Ohio. MAIN OUTCOME MEASURE(S) Baseline concussion test validity was determined using the ImPACT built-in validity measure. Experiences of adversity during the sensitive developmental periods of early childhood and adolescence were key independent variables. RESULTS Our findings suggested that social mobility may play an important role in baseline validity. Youth with upward social mobility (ie, poverty or neighborhood deprivation in early childhood only) were not different from youth without such experiences (odds ratio [OR] = 0.91, P = .74). Youth with persistent adversity across childhood or downward social mobility (ie, poverty or high neighborhood deprivation in adolescence only) had 50% to 72% lower odds of achieving a valid baseline test (persistent poverty, OR = 0.59, P = .05; adolescent poverty only, OR = 0.50, P = .004; adolescent neighborhood deprivation only, OR = 0.28, P < .001). Maltreatment had no significant effect on test validity. CONCLUSIONS These findings indicated that certain patterns of adversity may predispose youth to invalid baseline testing scores, potentially increasing their risk of inappropriate injury management and poor outcomes.
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Affiliation(s)
- Alena Sorensen D'Alessio
- Department of Population and Quantitative Health Sciences, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
- Center on Poverty and Community Development, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
| | - Meghan Salas Atwell
- Center on Poverty and Community Development, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
| | - Siran Koroukian
- Department of Population and Quantitative Health Sciences, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
| | - Christopher Bailey
- University Hospitals Concussion Management Program, Neurological Institute, University Hospitals Cleveland Medical Center, OH. Ms D'Alessio is now at the Department of Epidemiology, Gillings School of Global Public Health, and the Carolina Population Center, University of North Carolina at Chapel Hill. Dr Briggs is now at the Department of Public Health Sciences, University of Miami Miller School of Medicine, FL
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
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Steger V, Stadelmann S, White L, Döhnert M. Child abuse and pubertal timing: what is the role of child sex and identity of the perpetrator? BMC Psychiatry 2024; 24:242. [PMID: 38561781 PMCID: PMC10983734 DOI: 10.1186/s12888-024-05683-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND This study investigated the association between child abuse [child neglect (CN), emotional (CEA) and physical abuse (CPA)] and early puberty with special regard to sex-specific effects concerning child and parental perpetrator. METHODS Data assessment took place within the framework of the LIFE Child Depression study, a longitudinal study on the development of depressive symptoms and disorders between child- and adulthood in Leipzig, Germany. A sample of 709 children (8-14 years) was recruited from the general population and via psychiatric hospitals. Data on pubertal status were assessed using an instrument for self-assessment of tanner stages (scales of physical pubertal development). Information on menarche was provided by parents. The Parent-Child Conflict Tactics Scales (CTS-PC) served for data on child abuse. RESULTS Regarding physical puberty markers, significant correlations were found, especially with child neglect (CN) and child emotional abuse (CEA). Regression analyses, controlling for Body-Mass-Index (BMI) and Socioeconomic Status (SES), revealed that children affected by child neglect perpetrated by mother (CNm) and child emotional abuse (CEA) parent-non-specifically enter puberty significantly earlier. Sex-specific analyses identified child neglect perpetrated by mother (CNm) to be associated with early puberty in girls and child emotional abuse perpetrated by father (CEAf) with early puberty in boys. Concerning the onset of menstruation, there was a significant positive correlation between early menarche and parent-specific and non-specific child neglect (CN), as well as between early menarche and child emotional abuse perpetrated by the mother (CEAm). In regression models that controlled for Body-Mass-Index (BMI) and Socioeconomic Status (SES) no significant associations were maintained. Child physical abuse (CPA) was not associated with early puberty. CONCLUSION Results outlined child neglect (CN) and child emotional abuse (CEA) to be sex- and perpetrator-specific risk factors for early pubertal development. Knowledge of sex- and perpetrator-specific effects could help clinicians to specify their diagnostic process and to define differential prevention and treatment goals for children with experiences of CN and CEA. Further research on the sex-specific impact of parental CN and CEA on girls' and boys' puberty is needed.
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Affiliation(s)
- V Steger
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany.
- , Bremen, Germany.
| | - S Stadelmann
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - L White
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - M Döhnert
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, St Elisabeth & St Barbara Hospital, Barbarastraße 4, 06110, Halle (Saale), Germany
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Connell CM, Swanson AS, Genovese M, Lang JM. Effects of child trauma screening on trauma-informed multidisciplinary evaluation and service planning in the child welfare system. J Trauma Stress 2024; 37:337-343. [PMID: 38193592 DOI: 10.1002/jts.23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024]
Abstract
Despite the prevalence of exposure to potentially traumatic events (PTEs) among children involved with the child welfare system (CWS), trauma screening is not yet a common practice. The purpose of this study was to assess the impact of embedding a formal trauma screening process in statewide multidisciplinary evaluations for CWS-involved youth. A retrospective record review was conducted with two random samples of cases reflecting both pre- and postimplementation of formal screening procedures (n = 70 preimplementation, n = 100 postimplementation). Findings from the record review indicate statistically significant improvements in the documentation of general, χ2(1, N = 170) = 18.8, p < .001, and specific, χ2(1, N = 170) = 10.7, p = .001, details of children's reactions associated with PTE exposure, as well as increases in providers' recommendations, χ2(1, N = 170) = 18.1, p < .001, and referrals, χ2(1, N = 170) = 4.5, p = .034, for trauma-focused services. The early identification of trauma-related symptoms may help connect children more promptly to trauma-informed evidence-based interventions, which may avert or mitigate the long-term sequelae of child maltreatment and CWS involvement.
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Affiliation(s)
- Christian M Connell
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
- Child Maltreatment Solutions Network, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Ann Shun Swanson
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Maegan Genovese
- The Consultation Center, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason M Lang
- Child Health and Development Institute, Farmington, Connecticut, USA
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, UConn Health, Farmington, Connecticut, USA
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12
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[Important insights into the context and history of shaken baby syndrome and abusive head trauma (AHT)]. Ophthalmologie 2024; 121:331-332. [PMID: 38443492 DOI: 10.1007/s00347-024-02000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/07/2024]
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13
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Thomas A, Asnes A, Libby K, Hsiao A, Tiyyagura G. Developing and Testing the Usability of a Novel Child Abuse Clinical Decision Support System: Mixed Methods Study. J Med Internet Res 2024; 26:e51058. [PMID: 38551639 PMCID: PMC11015363 DOI: 10.2196/51058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Despite the impact of physical abuse on children, it is often underdiagnosed, especially among children evaluated in general emergency departments (EDs) and those belonging to racial or ethnic minority groups. Electronic clinical decision support (CDS) can improve the recognition of child physical abuse. OBJECTIVE We aimed to develop and test the usability of a natural language processing-based child abuse CDS system, known as the Child Abuse Clinical Decision Support (CA-CDS), to alert ED clinicians about high-risk injuries suggestive of abuse in infants' charts. METHODS Informed by available evidence, a multidisciplinary team, including an expert in user design, developed the CA-CDS prototype that provided evidence-based recommendations for the evaluation and management of suspected child abuse when triggered by documentation of a high-risk injury. Content was customized for medical versus nursing providers and initial versus subsequent exposure to the alert. To assess the usability of and refine the CA-CDS, we interviewed 24 clinicians from 4 EDs about their interactions with the prototype. Interview transcripts were coded and analyzed using conventional content analysis. RESULTS Overall, 5 main categories of themes emerged from the study. CA-CDS benefits included providing an extra layer of protection, providing evidence-based recommendations, and alerting the entire clinical ED team. The user-centered, workflow-compatible design included soft-stop alert configuration, editable and automatic documentation, and attention-grabbing formatting. Recommendations for improvement included consolidating content, clearer design elements, and adding a hyperlink with additional resources. Barriers to future implementation included alert fatigue, hesitancy to change, and concerns regarding documentation. Facilitators of future implementation included stakeholder buy-in, provider education, and sharing the test characteristics. On the basis of user feedback, iterative modifications were made to the prototype. CONCLUSIONS With its user-centered design and evidence-based content, the CA-CDS can aid providers in the real-time recognition and evaluation of infant physical abuse and has the potential to reduce the number of missed cases.
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Affiliation(s)
- Amy Thomas
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Andrea Asnes
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Kyle Libby
- 3M | M*Modal, 3M Health Information Systems, 3M Company, Maplewood, MN, United States
| | - Allen Hsiao
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Gunjan Tiyyagura
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
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Özer H, Abakli İnci M. Knowledge and experience of pediatricians and pedodontists in identifying and managing child abuse and neglect cases. Medicine (Baltimore) 2024; 103:e37548. [PMID: 38518005 PMCID: PMC10957004 DOI: 10.1097/md.0000000000037548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 03/24/2024] Open
Abstract
Child abuse, by definition parents and other family members, caregivers, or any adult he does not know culturally inappropriate, harmful to the child described, inhibiting growth and development, or exposure to a restrictive behavior. This study aims to evaluate the capabilities of pediatricians and pedodontists in identifying and managing child abuse and neglect within healthcare settings, a crucial responsibility for professionals across various medical disciplines. Questionnaire was performed on 53 pediatricians and 89 pedodontists. Utilizing a 28-item expert-designed electronic questionnaire, the study solicited responses from pediatricians and pedodontists to assess their demographic characteristics, professional experience, and self-perceived competence in this critical area. The results indicate that 42% of the participating healthcare providers have encountered at least one case of child abuse and neglect. Notably, pedodontists displayed a higher level of uncertainty in identifying abuse and neglect cases compared to pediatricians. Furthermore, participants who had a higher level of self-perceived competence were significantly more willing to identify and manage cases, although this self-assessment did not correlate with their actual skills or level of willingness to intervene effectively. The study concludes that there is a pressing need for specialized training programs tailored to enhance the skill sets of healthcare providers in identifying and managing child abuse and neglect. These programs should encompass not only academic knowledge but also practical applications and psychosocial support techniques to ensure a holistic approach to combating this serious issue.
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Affiliation(s)
- Hazal Özer
- Department of Pediatric Dentistry, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
| | - Merve Abakli İnci
- Department of Pediatric Dentistry, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
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Abdoo DC, Puls HT, Hall M, Lindberg DM, Anderst J, Wood JN, Parikh K, Tashijan M, Sills MR. Racial and ethnic disparities in diagnostic imaging for child physical abuse. Child Abuse Negl 2024; 149:106648. [PMID: 38262182 DOI: 10.1016/j.chiabu.2024.106648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
IMPORTANCE Racial bias may affect occult injury testing decisions for children with concern for abuse. OBJECTIVES To determine the association of race on occult injury testing decisions at children's hospitals. DESIGN In this retrospective study, we measured disparities in: (1) the proportion of visits for which indicated diagnostic imaging studies for child abuse were obtained; (2) the proportion of positive tests. SETTING The Pediatric Health Information System (PHIS) administrative database encompassing 49 tertiary children's hospitals during 2017-2019. PARTICIPANTS We built three cohorts based on guidelines for diagnostic testing for child abuse: infants with traumatic brain injury (TBI; n = 1952), children <2 years old with extremity fracture (n = 20,842), and children <2 years old who received a skeletal survey (SS; n = 13,081). MAIN OUTCOMES AND MEASURES For each group we measured: (1) the odds of receiving a specific guideline-recommended diagnostic imaging study; (2) among those with the indicated imaging study, the odds of an abuse-related injury diagnosis. We calculated both unadjusted and adjusted odds ratios (AOR) by race and ethnicity, adjusting for sex, age in months, payor, and hospital. RESULTS In infants with TBI, the odds of receiving a SS did not differ by racial group. Among those with a SS, the odds of rib fracture were higher for non-Hispanic Black than Hispanic (AOR 2.05 (CI 1.31, 3.2)) and non-Hispanic White (AOR 1.57 (CI 1.11, 2.32)) patients. In children with extremity fractures, the odds of receiving a SS were higher for non-Hispanic Black than Hispanic and non-Hispanic White patients (AOR 1.97 (CI 1.74, 2.23)); (AOR 1.17 (CI 1.05, 1.31)), respectively, and lower for Hispanic than non-Hispanic White patients (AOR 0.59 (CI 0.53, 0.67)). Among those receiving a SS, the rate of rib fractures did not differ by race. In children with skeletal surveys, the odds of receiving neuroimaging did not differ by race. Among those with neuroimaging, the odds of a non-fracture, non-concussion TBI were lower in non-Hispanic Black than Hispanic patients (AOR 0.7 (CI 0.57, 0.86)) and were higher among Hispanic than non-Hispanic White patients (AOR 1.23 (CI 1.02, 1.47)). CONCLUSIONS AND RELEVANCE We did not identify a consistent pattern of race-based disparities in occult injury testing when considering the concurrent yield for abuse-related injuries.
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Affiliation(s)
- Denise C Abdoo
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, United States of America.
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri- Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Matt Hall
- Children's Hospital Association, United States of America
| | - Daniel M Lindberg
- University of Colorado Anschutz Medical Campus, Department of Emergency Medicine, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, United States of America
| | - James Anderst
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri- Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Joanne N Wood
- Division of General Pediatrics, PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States of America
| | | | - Margaret Tashijan
- University of Colorado School of Medicine, Children's Hospital Colorado, United States of America
| | - Marion R Sills
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, United States of America
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Squier W. Retinodural haemorrhage of infancy, abusive head trauma, shaken baby syndrome: The continuing quest for evidence. Dev Med Child Neurol 2024; 66:290-297. [PMID: 37353945 DOI: 10.1111/dmcn.15676] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/25/2023]
Abstract
The shaken baby syndrome was originally proposed in the 1970s without any formal scientific basis. Once data generated by scientific research was available, the hypothesis became controversial. There developed essentially two sides in the debate. One side claimed that the clinical triad of subdural haemorrhage, retinal haemorrhage, and encephalopathy, or its components, is evidence that an infant has been shaken. The other side stated this is not a scientifically valid proposal and that alternative causes, such as low falls and natural diseases, should be considered. The controversy continues, but the contours have shifted. During the last 15 years, research has shown that the triad is not sufficient to infer shaking or abuse and the shaking hypothesis does not meet the standards of evidence-based medicine. This raises the issue of whether it is fit for either clinical practice or for the courtroom; evidence presented to the courts must be unassailable. WHAT THIS PAPER ADDS: There is insufficient scientific evidence to assume that an infant with the triad of subdural haemorrhage (SDH), retinal haemorrhage, and encephalopathy must have been shaken. Biomechanical and animal studies have failed to support the hypothesis that shaking can cause SDH and retinal haemorrhage. Patterns of retinal haemorrhage cannot distinguish abuse. Retinal haemorrhages are commonly associated with extracerebral fluid collections (including SDH) but not with shaking. Infants can develop SDH, retinal haemorrhage, and encephalopathy from natural diseases and falls as low as 1 foot. The shaking hypothesis and the literature on which it depends do not meet the standards of evidence-based medicine.
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Affiliation(s)
- Waney Squier
- Department of Neuropathology, John Radcliffe Hospital, Oxford, UK
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17
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Ridsdale L, Gilchrist F, Balmer RC, Skelton R, Sidebotham PD, Harris JC. British Society of Paediatric Dentistry: A policy document on dental neglect in children. Int J Paediatr Dent 2024; 34:160-168. [PMID: 37749962 DOI: 10.1111/ipd.13120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023]
Abstract
The British Society of Paediatric Dentistry's (BSPD) first policy document on dental neglect was published online in 2009. It proposed a new original definition of dental neglect, discussed the identification of dental neglect and recommended adopting a tiered response, with three stages of intervention according to level of concern. Furthermore, it detailed how the dental team should both contribute to the child protection process and implement wider measures to safeguard and promote children's welfare. Since 2009, these concepts have been widely adopted in the UK and beyond. Furthermore, there have been significant advances in both research and practice. Policy documents produced by the BSPD represent a majority view, based on the consideration of currently available evidence, and are tailored to a UK working environment. Although this updated document's recommendations remain broadly unchanged, this version reflects the professions' progress in understanding dental neglect and minor updates to terminology and, following a consultation process, has been amended to address the needs of two main audiences-dental professionals and nondental health and social care professionals-in order to enhance interdisciplinary working.
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Affiliation(s)
| | - Fiona Gilchrist
- Unit of Oral Health, Dentistry and Society, University of Sheffield, Sheffield, UK
- Charles Clifford Dental Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Ruth Skelton
- Bradford District and Craven Health and Care Partnership, Bradford, UK
| | | | - Jenny C Harris
- Unit of Oral Health, Dentistry and Society, University of Sheffield, Sheffield, UK
- Charles Clifford Dental Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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18
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King A, Pope E. Dermatitis versus nonaccidental trauma: A systematic review of initial pediatric misdiagnoses. Pediatr Dermatol 2024; 41:215-220. [PMID: 38400817 DOI: 10.1111/pde.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/27/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND/OBJECTIVES Pediatric dermatitis and nonaccidental trauma (NAT) may have overlapping cutaneous presentations, posing a risk of misdiagnosis and subsequent emotional distress and further harm. Through a systematic literature review, we reviewed pediatric (<18 years old) patients investigated for both dermatitis and NAT. METHODS EMBASE and MEDLINE databases were searched. English publications with original data involving pediatric patients investigated for both dermatitis and NAT were included. Nonhuman studies and incomplete articles/conference abstracts were excluded. Data extracted included the first author, year of publication, study design, participant count, sex of the population, age of the population, cutaneous presentation, timing of presentation, Child Protective Services involvement, and case relation to dermatitis and NAT. RESULTS This review included 21 case reports or series encompassing 29 patients. Among 26 patients initially investigated as NAT (26.9% involving Child Protective Services), final diagnoses included irritant contact dermatitis (53.8%), phytophotodermatitis (30.8%), allergic contact dermatitis (7.7%), perianal infectious dermatitis (3.8%), and atopic dermatitis (3.8%). Three patients initially diagnosed with nontraumatic dermatitis were later found to be victims of physical (2/3; 66.7%) or sexual abuse (1/3; 33.3%). CONCLUSIONS Effective history-taking and physical examinations should encompass a history of laxative use, contact with furocoumarin-containing plants/fruit, parallel family/peer cutaneous presentations, caregiver involvement, financial burden, patient discomfort, birthmark assessment, and lesions aligning with diaper borders or toilet seats. Limitations of this review include potential underreporting and the inclusion of low-quality study designs and evidence.
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Affiliation(s)
- Aliyah King
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Elena Pope
- Section of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Yock-Corrales A, Lee JH, Domínguez-Rojas JÁ, Caporal P, Roa JD, Fernandez-Sarmiento J, González-Dambrauskas S, Zhu Y, Abbas Q, Kazzaz Y, Dewi DS, Chong SL. A Multicenter Study on the Clinical Characteristics and Outcomes Among Children With Moderate to Severe Abusive Head Trauma. J Pediatr Surg 2024; 59:494-499. [PMID: 37867044 DOI: 10.1016/j.jpedsurg.2023.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION We aimed to identify clinical characteristics, risk factors for diagnosis, and describe outcomes among children with AHT. METHODS We performed an observational cohort study in tertiary care hospitals from 14 countries across Asia and Ibero-America. We included patients <5 years old who were admitted to participating pediatric intensive care units (PICUs) with moderate to severe traumatic brain injury (TBI). We performed descriptive analysis and multivariable logistic regression for risk factors of AHT. RESULTS 47 (12%) out of 392 patients were diagnosed with AHT. Compared to those with accidental injuries, children with AHT were more frequently < 2 years old (42, 89.4% vs 133, 38.6%, p < 0.001), more likely to arrive by private transportation (25, 53.2%, vs 88, 25.7%, p < 0.001), but less likely to have multiple injuries (14, 29.8% vs 158, 45.8%, p = 0.038). The AHT group was more likely to suffer subdural hemorrhage (SDH) (39, 83.0% vs 89, 25.8%, p < 0.001), require antiepileptic medications (41, 87.2% vs 209, 60.6%, p < 0.001), and neurosurgical interventions (27, 57.40% vs 143, 41.40%, p = 0.038). Mortality, PICU length of stay, and functional outcomes at 3 months were similar in both groups. In the multivariable logistic regression, age <2 years old (aOR 8.44, 95%CI 3.07-23.2), presence of seizures (aOR 3.43, 95%CI 1.60-7.36), and presence of SDH (aOR 9.58, 95%CI 4.10-22.39) were independently associated with AHT. CONCLUSIONS AHT diagnosis represented 12% of our TBI cohort. Overall, children with AHT required more neurosurgical interventions and the use of anti-epileptic medications. Children younger than 2 years and with SDH were independently associated with a diagnosis of AHT. TYPE OF STUDY Observational cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adriana Yock-Corrales
- Emergency Department.Hospital Nacional de Niños ¨Dr. Carlos Sáenz Herrera. CCSS San José, Costa Rica.
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital. Singapore
| | | | - Paula Caporal
- Hospital Interzonal Especializado en Pediatría "Sor María Ludovica", Buenos Aires, Argentina
| | - Juan D Roa
- Fundación Homi, Universidad Nacional de Colombia - FUCS, Bogotá, Colombia
| | - Jaime Fernandez-Sarmiento
- Department of Critical Care Medicine and Pediatrics, Universidad de La Sabana. Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Sebastián González-Dambrauskas
- Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República Montevideo, Uruguay
| | - Yanan Zhu
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation. Singapore
| | - Qalab Abbas
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan Karachi, Karachi City, Sindh, Pakistan
| | - Yasser Kazzaz
- Department of Paediatrics, Ministry of National Guards Health Affairs, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre Riyadh, Saudi Arabia
| | - Dianna Sri Dewi
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
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Baghdadi S, Momtaz D, Torres-Izquierdo B, Pereira DE, Gonuguntla R, Mittal M, Hosseinzadeh P. The shifting trends in the epidemiology and risk factors of non-accidental fractures in children. Child Abuse Negl 2024; 149:106692. [PMID: 38395018 DOI: 10.1016/j.chiabu.2024.106692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/11/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Fractures are a common presentation of non-accidental trauma (NAT) in the pediatric population. However, the presentation could be subtle, and a high degree of suspicion is needed not to miss NAT. OBJECTIVE To analyze a comprehensive database, providing insights into the epidemiology of fractures associated with NAT. PARTICIPANTS AND SETTING The TriNetX Research Network was utilized for this study, containing medical records from 55 healthcare organizations. TriNetX was queried for all visits in children under the age of 6 years from 2015 to 2022, resulting in a cohort of over 32 million. METHODS All accidental and non-accidental fractures were extracted and analyzed to determine the incidence, fracture location, and demographics of NAT. Statistical analysis was done on a combination of Python and Epipy. RESULTS Overall, 0.36 % of all pediatric patients had a diagnosis of NAT, and 4.93 % of fractures (34,038 out of 689,740 total fractures) were determined to be non-accidental. Skull and face fractures constituted 17.9 % of all NAT fractures, but rib/sternum fractures had an RR = 6.7 for NAT. Children with intellectual and developmental disability (IDD) or autism spectrum disorder (ASD) had a 9 times higher risk for non-accidental fractures. The number of non-accidental fractures significantly increased after 2019. CONCLUSIONS The study findings suggest that nearly 1 out of all 20 fractures in children under age 6 are caused by NAT, and that rib/sternum fractures are most predictive of an inflicted nature. The study also showed a significant increase in the incidence of NAT, during and after the pandemic.
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Affiliation(s)
- Soroush Baghdadi
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - David Momtaz
- UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, USA
| | | | - Daniel E Pereira
- Washington University School of Medicine, Department of Orthopaedics, St. Louis, MO, USA
| | - Rishi Gonuguntla
- UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, USA
| | | | - Pooya Hosseinzadeh
- Washington University School of Medicine, Department of Orthopaedics, St. Louis, MO, USA.
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Brink FW, Lo CB, Rust SW, Puls HT, Stanley R, Galdo B, Lindberg DM. Pilot study using machine learning to improve estimation of physical abuse prevalence. Child Abuse Negl 2024; 149:106681. [PMID: 38368780 DOI: 10.1016/j.chiabu.2024.106681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/08/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes have been shown to underestimate physical abuse prevalence. Machine learning models are capable of efficiently processing a wide variety of data and may provide better estimates of abuse. OBJECTIVE To achieve proof of concept applying machine learning to identify codes associated with abuse. PARTICIPANTS AND SETTING Children <5 years, presenting to the emergency department with an injury or abuse-specific ICD-10-CM code and evaluated by the child protection team (CPT) from 2016 to 2020 at a large Midwestern children's hospital. METHODS The Pediatric Health Information System (PHIS) and the CPT administrative databases were used to identify the study sample and injury and abuse-specific ICD-10-CM codes. Subjects were divided into abused and non-abused groups based on the CPT's evaluation. A LASSO logistic regression model was constructed using ICD-10-CM codes and patient age to identify children likely to be diagnosed by the CPT as abused. Performance was evaluated using repeated cross-validation (CV) and Reciever Operator Characteristic curve. RESULTS We identified 2028 patients evaluated by the CPT with 512 diagnosed as abused. Using diagnosis codes and patient age, our model was able to accurately identify patients with confirmed PA (mean CV AUC = 0.87). Performance was still weaker for patients without existing ICD codes for abuse (mean CV AUC = 0.81). CONCLUSIONS We built a model that employs injury ICD-10-CM codes and age to improve accuracy of distinguishing abusive from non-abusive injuries. This pilot modelling endeavor is a steppingstone towards improving population-level estimates of abuse.
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Affiliation(s)
- Farah W Brink
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 West Ninth Avenue, Columbus, OH 43210, United States.
| | - Charmaine B Lo
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, United States; Abigail Wexner Research Institute, 700 Children's Drive, Columbus, OH 43205, United States
| | - Steven W Rust
- IT Research & Innovation, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Henry T Puls
- Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States
| | - Rachel Stanley
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 West Ninth Avenue, Columbus, OH 43210, United States
| | - Brendan Galdo
- IT Research & Innovation, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Daniel M Lindberg
- The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, 13123 East 16(th) Avenue, Aurora, CO 80045, United States; Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, 13001 East 17(th) Place, Aurora, CO 80045, United States
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Sokoloff M, Feldman KW, Levin AV, Rockter A, Armijo-Garcia V, Musick M, Weeks K, Haney SB, Marinello M, Herman BE, Frazier TN, Carroll CL, Hymel KP. Retinal hemorrhage variation in inertial versus contact head injuries. Child Abuse Negl 2024; 149:106606. [PMID: 38134727 DOI: 10.1016/j.chiabu.2023.106606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Abusive head trauma (AHT) is frequently accompanied by dense/extensive retinal hemorrhages to the periphery with or without retinoschisis (complex retinal hemorrhages, cRH). cRH are uncommon without AHT or major trauma. OBJECTIVE The study objectives were to determine whether cRH are associated with inertial vs. contact mechanisms and are primary vs. secondary injuries. PARTICIPANTS AND SETTING This retrospective study utilized a de-identified PediBIRN database of 701 children <3-years-old presenting to intensive care for head trauma. Children with motor vehicle related trauma and preexisting brain abnormalities were excluded. All had imaging showing head injury and a dedicated ophthalmology examination. METHODS Contact injuries included craniofacial soft tissue injuries, skull fractures and epidural hematoma. Inertial injuries included acute impairment or loss of consciousness and/or bilateral and/or interhemispheric subdural hemorrhage. Abuse was defined in two ways, by 1) predetermined criteria and 2) caretaking physicians/multidisciplinary team's diagnostic consensus. RESULTS PediBIRN subjects with cRH frequently experienced inertial injury (99.4 % (308/310, OR = 53.74 (16.91-170.77)) but infrequently isolated contact trauma (0.6 % (2/310), OR = 0.02 (0.0004-0.06)). Inertial injuries predominated over contact trauma among children with cRH sorted AHT by predetermined criteria (99.1 % (237/239), OR = 20.20 (6.09-67.01) vs 0.5 % (2/339), OR = 0.04 (0.01-0.17)). Fifty-nine percent of patients with cRH, <24 h altered consciousness, and inertial injuries lacked imaging evidence of brain hypoxia, ischemia, or swelling. CONCLUSIONS cRH are significantly associated with inertial angular acceleration forces. They can occur without brain hypoxia, ischemia or swelling suggesting they are not secondary injuries.
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Affiliation(s)
- Michael Sokoloff
- Department of Pediatrics, Pediatric Intensive Care, Sacred Heart Children's Hospital, Spokane, WA, United States of America.
| | - Kenneth W Feldman
- Department of Pediatrics, Seattle Children's, University of Washington's Harborview Medical Center, Seattle, WA, United States of America; Department of Pediatrics, Safe Child and Adolescent Network, Seattle Children's, Seattle, WA, United States of America.
| | - Alex V Levin
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester, Rochester, NY, United States of America.
| | - Adam Rockter
- University of Rochester School of Medicine, Rochester, NY, United States of America.
| | - Veronica Armijo-Garcia
- Department of Pediatrics, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, United States of America.
| | - Matthew Musick
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States of America.
| | - Kerri Weeks
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, KS, United States of America.
| | - Suzanne B Haney
- Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States of America.
| | - Mark Marinello
- Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA, United States of America.
| | - Bruce E Herman
- Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, United States of America.
| | - Terra N Frazier
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States of America.
| | - Christopher L Carroll
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, United States of America.
| | - Kent P Hymel
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States of America
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23
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Azadani EN, McTigue DJ, Peng J, Casamassimo PS. Associations between child abuse and neglect, and dento-alveolar injuries in a Children's hospital population. Dent Traumatol 2024; 40 Suppl 2:53-60. [PMID: 37946618 DOI: 10.1111/edt.12902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND/AIM The purpose of this study was to identify social variables common to children with dento-alveolar trauma (DAT) and child abuse and neglect (CAN) in a large children's hospital population. METHODS Emergency department data from an urban trauma Level 1 children's hospital were queried between December 02, 2017 and September 30, 2022 to identify children with both DAT and CAN. Patients with DAT and CAN were compared to DAT-only children in a case-control study design. Descriptive statistics were used to report characteristics of children in case and control groups. Chi-Squared and Fisher's exact tests were used to compare cases and controls. The level of significance was set at p ≤ .05. RESULTS In total, 14 children who had DAT and CAN reported simultaneously comprised the case group. A total of 42 children with DAT-only, age/sex matched with cases, comprised the control group. Mean (SD) age of cases was 10.4 (±4) and controls was 10.1 (±3.9) years-old. Eight cases (57.1%) and 24 controls (57.1%) were female. No statistical differences (p = .05) were present for language, race, insurance coverage, parental custody, legal guardianship, and type of residence for cases versus controls. Five (35.7%) cases had a special need versus 4 (9.5%) controls and was statistically different (p = .03). Nine (64.3%) cases had behavioral problems versus 13 (31%) controls (p = .05). Cases were more likely to have facial injuries than controls (74.3 vs. 31%), however no significant differences were present for total number of injured teeth, head injury or neck injury between cases and controls. In half of cases, the perpetrator reported was the sibling. CONCLUSIONS Demographics did not predict CAN in children with dental injuries. Sibling violence should be considered in suspected CAN children.
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Affiliation(s)
- Ehsan N Azadani
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
- Department of Dentistry, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dennis J McTigue
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
- Department of Dentistry, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jin Peng
- Information Technology Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Paul S Casamassimo
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
- Department of Dentistry, Nationwide Children's Hospital, Columbus, Ohio, USA
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24
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Merrild CH. Turning Towards the Affective: Medical Semiotics of Child Maltreatment in Denmark. Med Anthropol 2024; 43:161-173. [PMID: 37651622 DOI: 10.1080/01459740.2023.2250059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Signs of child maltreatment may be physical and detectable by clinical examination but may also arise as a feeling of strangeness that sparks uncertainty. Based on fieldwork in Danish general practice, and thinking along recent discussions around semiotics and affect, the article explores how feelings of "strangeness" arise in child consultations. It focuses on how subjective, embodied, and interpersonal reactions arise, how signs, however tactile and arbitrary, are felt and experienced, and how engaging with affective aspects when doing diagnosis, could expand the medical semiotics of child maltreatment.
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25
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Horiuchi A, Nishimura T, Taniike M, Tachibana M. Development of a rating scale for maladaptive symptoms by maltreatment: Perspectives of attachment and dissociation. PLoS One 2024; 19:e0298214. [PMID: 38354189 PMCID: PMC10866495 DOI: 10.1371/journal.pone.0298214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/21/2024] [Indexed: 02/16/2024] Open
Abstract
Child abuse has been increasing in Japan. Abused children's behavior may often be confused with neurodevelopmental disorders; therefore, specialized tools to identify these cases and specific care for maltreatment are crucial. This study aimed to develop an objective early screening scale for abuse-related maladaptive symptoms. To do this, two surveys were conducted. Survey 1 included 60 children attending public elementary schools, who had been admitted to orphanages due to abuse (maltreated group), and 154 children attending public elementary schools with no reported maltreatment (control group). In this survey, 40 existing scale items related to attachment behavior and dissociative symptoms were evaluated. Childcare staff and homeroom teachers evaluated children's behaviors. Receiver operating characteristic (ROC) curves were drawn to determine optimal cut-off values. In Survey 2, 39 children in the maltreatment group and 186 children in the control group were subjected to confirmatory factor analysis to examine the new scale's reliability and validity. Based on the results of an exploratory factor analysis, a two-factor, 20-item rating scale for maladaptive symptoms due to maltreatment (RS-MSM) was developed. The receiver operating characteristic curve indicated that cutoff values set in Survey 1 were appropriate for screening the general population and children in the clinical range. The results confirmed a two-factor structure with high reliability and convergent validity in the Survey 2 sample. Therefore, the developed RS-MSM scale is valid and will allow for easy screening of maltreated children at school.
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Affiliation(s)
- Aika Horiuchi
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Tomoko Nishimura
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masako Taniike
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Japan
- Molecular Research Center for Children’s Mental Development, United Graduate School of Child Development, Osaka University, Suita, Japan
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masaya Tachibana
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Japan
- Molecular Research Center for Children’s Mental Development, United Graduate School of Child Development, Osaka University, Suita, Japan
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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26
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Gupta H, Choudhary B. Caffey's disease in disguise: a child abuse mimic. BMJ Case Rep 2024; 17:e256998. [PMID: 38331449 PMCID: PMC10859985 DOI: 10.1136/bcr-2023-256998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
A male infant was brought in a paediatric emergency with swelling in the right hand associated with restriction of wrist movements. Examination confirmed similar findings. The history of trauma was not forthcoming. Given the ambiguous history, the possibility of child abuse was kept. X-ray showed local soft tissue swelling with periosteal thickening and raised inflammatory markers in blood tests, which on review of the literature, was consistent with Caffey disease. Due to the self-limiting nature of the condition, the child was managed conservatively. Child abuse should be suspected in children with unexplained injuries, and before labelling abuse, its mimickers should be ruled out.
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Affiliation(s)
- Himanshu Gupta
- Pediatrics, All India Institute of Medical Sciences Jodphur, Jodhpur, India
| | - Bharat Choudhary
- Trauma & Emergency (Pediatrics), All India Institute of Medical Sciences Jodphur, Jodhpur, India
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27
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Willems A, Weston L, Robertson S. Skin fragility disorder misdiagnosed as child abuse: a cautionary tale. Med J Aust 2024; 220:71-73. [PMID: 38129121 DOI: 10.5694/mja2.52188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/26/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Anneliese Willems
- Doctors On Nicholson, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Lauren Weston
- Royal Children's Hospital Melbourne, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
| | - Susan Robertson
- Royal Children's Hospital Melbourne, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
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28
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Mostovoy D, Masarwa D, Niazov Y, Ben Natan M. Ophthalmologists' Attitudes, Knowledge, and Willingness to Report Child Abuse. Child Maltreat 2024; 29:47-52. [PMID: 35833516 DOI: 10.1177/10775595221114778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of the present study was to explore ophthalmologists' attitudes, knowledge, and willingness to report child abuse. One-hundred-and-seven ophthalmologists employed in various hospitals in Israel completed an online questionnaire. Less than half the ophthalmologists (44.9%) reported that they had treated children whom they identified or suspected as being victims of child abuse, while only 43.9% of these reported child abuse. Despite generally positive attitudes towards reporting of child abuse among the ophthalmologists, their average level of knowledge was low. Ophthalmologists who had received training on child abuse and residents displayed a higher level of knowledge. In addition, female ophthalmologists tended to agree more that ophthalmologists are obligated to screen for and report child abuse. Moreover, female ophthalmologists expressed higher willingness to report child abuse. The present study reveals that underreporting of child abuse, and more precisely the discrepancy between identification and reporting, is present among ophthalmologists. It seems that lack of knowledge regarding identification and reporting of child abuse is the main barrier to reporting, especially among medical specialists. These findings underscore the importance of training programs on child abuse, both during formal education in medical school, and post-qualification, for all ophthalmologists, irrespective of seniority.
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Affiliation(s)
- Dina Mostovoy
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Dua Masarwa
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Yulia Niazov
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
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29
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Nomakuchi TT, Alves CAP, Beslow LA, Zarnow D, Goyal N, Zackai EH, Reynoso Santos FJ. Subdural Hemorrhage as an Early Presentation in a Case of Sotos Syndrome. Neuropediatrics 2024; 55:71-74. [PMID: 36914163 DOI: 10.1055/a-2052-8750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Subdural hemorrhages (SDHs) in the pediatric population are associated with a high mortality and morbidity and may present in the context of abusive head trauma. Diagnostic investigations for such cases often include evaluation for rare genetic and metabolic disorders that can have associated SDH. Sotos syndrome is an overgrowth syndrome associated with macrocephaly and increased subarachnoid spaces and rarely with neurovascular complications. Here, we report two cases of Sotos syndrome, one with SDH during infancy who underwent repeated evaluation for suspected child abuse prior to the Sotos syndrome diagnosis and the other with enlarged extra-axial cerebrospinal fluid spaces, demonstrating a possible mechanism for SDH development in this setting. These cases suggest that some individuals with Sotos syndrome may be at elevated risk of developing SDH in infancy and that Sotos syndrome should be on the differential diagnosis during a medical genetics evaluation in cases of unexplained SDH, especially in the setting of macrocephaly.
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Affiliation(s)
- Tomoki T Nomakuchi
- Division of Human Genetics, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Cesar Augusto P Alves
- Division of Neuroradiology, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania, United States
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
| | - Deborah Zarnow
- Division of Neuroradiology, Children's Hospital of Philadelphia, Pennsylvania, United States
- Department of Radiology Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
| | - Neera Goyal
- Department of Pediatrics, Nemours Children's Health and Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Pennsylvania, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
| | - Francis Jeshira Reynoso Santos
- Division of Human Genetics, Children's Hospital of Philadelphia, Pennsylvania, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
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30
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Kopland MCG, Vrabel K, Slof-Op 't Landt M, Hoffart A, Johnson SU, Giltay EJ. Breaking the cycle: Identifying key symptom pathways of eating disorders and the influence of childhood maltreatment. Int J Eat Disord 2024; 57:316-326. [PMID: 38006259 DOI: 10.1002/eat.24097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Most network analyses on central symptoms in eating disorders (EDs) have been cross-sectional. Longitudinal within-person analyses of therapy processes are scarce. Our aim was to investigate central change processes in therapy in a transdiagnostic sample, considering the influence of childhood maltreatment. METHOD We employed dynamic time warping analyses to identify clusters of symptoms that tended to change similarly across therapy on a within-person level. Symptoms were measured by a 28-item Eating Disorder Examination Questionnaire (EDE-Q). Furthermore, we examined the temporal direction of symptom change to identify symptoms that tended to precede and predict other symptoms. Finally, we estimated two directed, temporal networks in patients with and without a history of childhood maltreatment. RESULTS Our analysis included 122 ED patients (mean age = 30.9, SD = 9.7; illness duration = 14.2 years, SD = 8.9; prior treatment = 5.6 years, SD = 5.1). The initial network revealed three robust clusters of symptoms over time: (1) ED behavior, (2) inhibition, and (3) cognitions and feelings about body and weight. Overvaluation of shape had the highest out-strength preceding and predicting other symptoms. Dissatisfaction with weight preceded and predicted other symptoms in the maltreatment network. The non-maltreatment network showed a similar structure to the transdiagnostic network. CONCLUSION Targeting and monitoring feelings and cognitions related to shape may be crucial for achieving lasting symptom improvement in a transdiagnostic sample. Furthermore, our findings highlight the need for further investigation into the different processes driving EDs based on maltreatment status. PUBLIC SIGNIFICANCE There is limited understanding of the processes that occur for patients with eating disorders between admission and discharge in therapy, especially for patients with a history of childhood maltreatment. Our analyses suggest that changes in cognitions regarding shape precede and predict changes in cognitions about weight. Different processes may be driving the eating disorder according to maltreatment status, which might further illuminate the riddle of dropout and relapse in therapy for patients with a history of childhood maltreatment. These findings suggest the need for further investigation into the specific dynamics occurring during therapy for individuals with a history of childhood maltreatment.
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Affiliation(s)
- Maren C G Kopland
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - KariAnne Vrabel
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Margarita Slof-Op 't Landt
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - Asle Hoffart
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Sverre Urnes Johnson
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Health Campus The Hague, Leiden University, Leiden, The Netherlands
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31
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Martin NR, Claypool AL, Diyaolu M, Chan KS, A'Neals E, Iyer K, Stewart CC, Egge M, Bernacki K, Hallinan M, Zuo L, Gupta U, Naru N, Scheinker D, Morris AM, Brandeau ML, Chao S. SCAN for Abuse: Electronic Health Record-Based Universal Child Abuse Screening. J Pediatr Surg 2024; 59:337-341. [PMID: 37953157 PMCID: PMC10842334 DOI: 10.1016/j.jpedsurg.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Identification of physical abuse at the point of care without a systematic approach remains inherently subjective and prone to judgement error. This study examines the implementation of an electronic health record (EHR)-based universal child injury screen (CIS) to improve detection rates of child abuse. METHODS CIS was implemented in the EHR admission documentation for all patients age 5 or younger at a single medical center, with the following questions. 1) "Is this patient an injured/trauma patient?" 2) "If this is a trauma/injured patient, where did the injury occur?" A "Yes" response to Question 1 would alert a team of child abuse pediatricians and social workers to determine if a patient required formal child abuse clinical evaluation. Patients who received positive CIS responses, formal child abuse work-up, and/or reports to Child Protective Services (CPS) were reviewed for analysis. CPS rates from historical controls (2017-2018) were compared to post-implementation rates (2019-2021). RESULTS Between 2019 and 2021, 14,150 patients were screened with CIS. 286 (2.0 %) patients screened received positive CIS responses. 166 (58.0 %) of these patients with positive CIS responses would not have otherwise been identified for child abuse evaluation by their treating teams. 18 (10.8 %) of the patients identified by the CIS and not by the treating team were later reported to CPS. Facility CPS reporting rates for physical abuse were 1.2 per 1000 admitted children age 5 or younger (pre-intervention) versus 4.2 per 1000 (post-intervention). CONCLUSIONS Introduction of CIS led to increased detection suspected child abuse among children age 5 or younger. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Study of Diagnostic Test.
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Affiliation(s)
| | - Anneke L Claypool
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | | | - Katelyn S Chan
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Karan Iyer
- Lucile Packard Children's Hospital, Stanford, CA, USA
| | | | - Melissa Egge
- Lucile Packard Children's Hospital, Stanford, CA, USA
| | | | | | - Linda Zuo
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Urvi Gupta
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Navleen Naru
- Stanford University School of Medicine, Stanford, CA, USA
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA; Stanford University School of Medicine, Stanford, CA, USA
| | - Arden M Morris
- Stanford University School of Medicine, Stanford, CA, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Stephanie Chao
- Stanford University School of Medicine, Stanford, CA, USA
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32
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Meyer LM, Lehmann T, Schüler IM. Child abuse and neglect: A comparative study between dental and medical students' competencies in Germany. Eur J Dent Educ 2024; 28:302-312. [PMID: 37661599 DOI: 10.1111/eje.12950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/02/2023] [Accepted: 07/30/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Despite children's right to a non-violent upbringing, they become daily victims of violence. Physical violence concerns mostly the head-especially the orofacial area. Therefore, dentists and paediatricians should be able to suspect possible abuse and to initiate child protection. This study aimed to record and compare the training situation and competencies of dental and medical students at Jena University Hospital regarding child abuse and neglect (CAN). MATERIALS AND METHODS Using a three-part questionnaire about CAN, 123 medical and 77 dental students were surveyed anonymously after completing all courses on the topic. The question sets included as follows: (1) educational experiences, training content and satisfaction; (2) current knowledge regarding diagnostic, management and legal concerns; (3) self-evaluation, needs of further education and wishes. Reliability of the questionnaire was tested with kappa-statistics and assessed as good. RESULTS Dental and medical students' overall satisfaction with CAN-related training is low. Although medical students had more knowledge on CAN, all participants showed large deficits. Better diagnostic than management skills were reported in both groups. Only 1.3% dental and 16.3% medical students felt adequately prepared to deal with CAN. 7% of all study participants stated that they can report CAN without any help. 87.0% of medical and 79.2% of dental students expressed a desire for further education. To improve their knowledge, both courses prefer seminars, followed by expert talks, lectures and simulation-based training (SkillsLab). CONCLUSION Dental and medical students are inadequately prepared to suspect possible abuse and to deal with possible signs of CAN. Mandatory interdisciplinary courses and lectures addressing CAN are recommendable for both medical and dental curricula.
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Affiliation(s)
- Lisa-Marie Meyer
- Department of Orthodontics, Section of Preventive and Pediatric Dentistry, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - Ina Manuela Schüler
- Department of Orthodontics, Section of Preventive and Pediatric Dentistry, Jena University Hospital, Jena, Germany
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33
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Ortiz R, Kershaw KN, Zhao S, Kline D, Brock G, Jaffee S, Golden SH, Ogedegbe G, Carroll J, Seeman TE, Joseph JJ. Evidence for the Association Between Adverse Childhood Family Environment, Child Abuse, and Caregiver Warmth and Cardiovascular Health Across the Lifespan: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Circ Cardiovasc Qual Outcomes 2024; 17:e009794. [PMID: 38258561 DOI: 10.1161/circoutcomes.122.009794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 09/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND This study aimed to quantify the association between childhood family environment and longitudinal cardiovascular health (CVH) in adult CARDIA (Coronary Artery Risk Development in Young Adults) Study participants. We further investigated whether the association differs by adult income. METHODS We applied the CVH framework from the American Heart Association including metrics for smoking, cholesterol, blood pressure, glucose, body mass index, physical activity, and diet. CVH scores (range, 0-14) were calculated at years 0, 7, and 20 of the study. Risky Family environment (range, 7-28) was assessed at year 15 retrospectively, for childhood experiences of abuse, caregiver warmth, and family or household challenges. Complete case ordinal logistic regression and mixed models associated risky family (exposure) with CVH (outcome), adjusting for age, sex, race, and alcohol use. RESULTS The sample (n=2074) had a mean age of 25.3 (±3.5) years and 56% females at baseline. The median risky family was 10 with ideal CVH (≥12) met by 288 individuals at baseline (28.4%) and 165 (16.3%) at year 20. Longitudinally, for every 1-unit greater risky family, the odds of attaining high CVH (≥10) decreased by 3.6% (OR, 0.9645 [95% CI, 0.94-0.98]). Each unit greater child abuse and caregiver warmth score corresponded to 12.8% lower and 11.7% higher odds of ideal CVH (≥10), respectively (OR, 0.872 [95% CI, 0.77-0.99]; OR, 1.1165 [95% CI, 1.01-1.24]), across all 20 years of follow-up. Stratified analyses by income in adulthood demonstrated associations between risky family environment and CVH remained significant for those of the highest adult income (>$74k), but not the lowest (<$35k). CONCLUSIONS Although risky family environmental factors in childhood increase the odds of poor longitudinal adult CVH, caregiver warmth may increase the odds of CVH, and socioeconomic attainment in adulthood may contextualize the level of risk. Toward a paradigm of primordial prevention of cardiovascular disease, childhood exposures and economic opportunity may play a crucial role in CVH across the life course.
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Affiliation(s)
- Robin Ortiz
- Departments of Pediatrics and Population Health, New York University, Grossman School of Medicine (R.O.)
- Institute for Excellence in Health Equity, New York University Langone Health (R.O., G.O.)
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (K.N.K.)
| | - Songzhu Zhao
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus (S.Z., G.B.)
| | - David Kline
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (D.K.)
| | - Guy Brock
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus (S.Z., G.B.)
| | - Sara Jaffee
- Department of Psychology, The University of Pennsylvania, Philadelphia (S.J.)
| | - Sherita H Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.H.G.)
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Langone Health (R.O., G.O.)
- Department of Medicine, New York University, Grossman School of Medicine (G.O.)
| | - Judith Carroll
- The University of California, Los Angeles, David Geffen School of Medicine, Jane and Terri Semel Institute for Neuroscience and Human Behavior, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences (J.C.)
| | - Teresa E Seeman
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (T.E.S.)
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus (J.J.J.)
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Abstract
Child abuse pediatrics (CAP) subspecialists evaluate, diagnose, and treat children when abuse or neglect is suspected. Despite the high rates of child maltreatment across the United States, CAP remains the smallest pediatric subspecialty. The CAP workforce faces numerous challenges, including few fellows entering the field, decreased financial compensation compared with other fields of medicine, and threats to workforce retention, including secondary trauma and harmful exposure in the media. A microsimulation model that estimates the future of the US CAP workforce over the next 20 years shows that, although the number of child abuse pediatricians in the field is expected to increase, the growth is smaller than that of every other pediatric subspecialty. In addition to the low overall CAP workforce in the United States, other workforce issues include the need to increase CAP subspecialists who are underrepresented in medicine and unequal geographic distribution across the country. To meet the medical needs of suspected victims of maltreatment, especially in CAP-underserved areas, many children are evaluated by providers who are not board-certified in CAP, such as general pediatricians, family medicine physicians, emergency medicine physicians, and advanced practice providers, whose CAP experience and training may vary. Current child abuse pediatricians should continue introducing the field to medical students and residents, especially those who identify as underrepresented in medicine or are from CAP-underserved areas, and offer mentorship, continuing education, and oversight to non-CAP physicians meeting this population's medical needs.
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Affiliation(s)
- Brett Slingsby
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Angela Bachim
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina
- Tufts University School of Medicine, Boston, Massachusetts
| | - Mary E Moffatt
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
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Golonka M, Liu Y, Rohrs R, Copeland J, Byrd J, Stilwell L, Crew C, Kuehn M, Snyder-Fickler E, Hurst JH, Evans KE, Terrell L, Gifford EJ. What Do Child Abuse and Neglect Medical Evaluation Consultation Notes Tell Researchers and Clinicians? Child Maltreat 2024; 29:117-128. [PMID: 36265843 PMCID: PMC10601986 DOI: 10.1177/10775595221134537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Child abuse and neglect (CAN) medical experts provide specialized multidisciplinary care to children when there is concern for maltreatment. Their clinical notes contain valuable information on child- and family-level factors, clinical concerns, and service placements that may inform the needed supports for the family. We created and implemented a coding system for data abstraction from these notes. Participants were 1,397 children ages 0-17 years referred for a consultation with a CAN medical provider at an urban teaching and research hospital between March 2013 and December 2017. Coding themes were developed using an interdisciplinary team-based approach to qualitative analysis, and descriptive results are presented using a developmental-contextual framework. This study demonstrates the potential value of developing a coding system to assess characteristics and patterns from CAN medical provider notes, which could be helpful in improving quality of care and prevention and detection of child abuse.
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Affiliation(s)
- Megan Golonka
- Center for Child and Family Policy, Duke University, Durham, NC, USA
- Center for the Study of Adolescent Risk and Resilience, Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Yuerong Liu
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Rosie Rohrs
- Eliot-Pearson Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | - Jennifer Copeland
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Jessalyn Byrd
- School of Nursing, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Laura Stilwell
- Duke University School of Medicine, Durham, NC, USA
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Carter Crew
- Division of Reproductive, Maternal, Newborn, and Child Health, FHI 360, Durham, NC, USA
| | - Molly Kuehn
- Duke University School of Medicine, Durham, NC, USA
| | | | - Jillian H Hurst
- Children's Health and Discovery Initiative, Duke University, Durham, NC, USA
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Kelly E Evans
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Lindsay Terrell
- Department of Pediatrics, Duke Children's Primary Care, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth J Gifford
- Center for Child and Family Policy, Duke University, Durham, NC, USA
- Sanford School of Public Policy, Duke University, Durham, NC, USA
- Children's Health and Discovery Initiative, Duke University, Durham, NC, USA
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
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Mamaril-Davis JC, Riordan K, Sumdani H, Bowlby P, Emami Neyestanak M, Simpson L, Avellino AM, Tang A, Weinand ME. Subdural hematoma, retinal hemorrhage, and fracture triad as a clinical predictor for the diagnosis of child abuse. J Neurosurg Pediatr 2024; 33:142-148. [PMID: 38039524 DOI: 10.3171/2023.11.peds23212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Nonaccidental trauma (NAT) is a major cause of traumatic death during infancy and early childhood. Several findings are known to raise the index of clinical suspicion: subdural hematoma (SDH), retinal hemorrhage (RH), fracture, and external trauma. Combinations of certain injury types, determined via statistical frequency associations, may assist clinical diagnostic tools when child abuse is suspected. The present study sought to assess the statistical validity of the clinical triad (SDH + RH + fracture) in the diagnosis of child abuse and by extension pediatric NAT. METHODS A retrospective review of The University of Arizona Trauma Database was performed. All patients were evaluated for the presence or absence of the components of the clinical triad according to specific International Classification of Diseases (ICD)-10 codes. Injury type combinations included some variation of SDH, RH, all fractures, noncranial fracture, and cranial fracture. Each injury type was then correlated with the ICD-10 codes for child abuse or injury comment keywords. Statistical analysis via contingency tables was then conducted for test characteristics such as sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS There were 3149 patients younger than 18 years of age included in the quantitative analysis, all of whom had at least one component of the clinical triad. From these, 372 patients (11.8%) had a diagnosis of child abuse. When compared to a single diagnosis of either SDH, RH, all fractures, noncranial fracture, or cranial fracture, the clinical triad had a significantly greater correlation with the diagnosis of child abuse (100% of cases) (p < 0.0001). The dyad of SDH + RH also had a significantly greater correlation with a child abuse diagnosis compared to single diagnoses (88.9%) (p < 0.0001). The clinical triad of SDH + RH + fracture had a sensitivity of 88.8% (95% CI 87.6%-89.9%), specificity of 100% (95% CI 83.9%-100%), and positive predictive value of 100% (95% CI 99.9%-100%). The dyad of SDH + RH had a sensitivity of 89.1% (95% CI 87.9%-90.1%), specificity of 88.9% (95% CI 74.7%-95.6%), and positive predictive value of 99.9% (95% CI 99.6%-100%). All patients with the clinical triad were younger than 3 years of age. CONCLUSIONS When SDH, RH, and fracture were present together, child abuse and by extension pediatric NAT were highly likely to have occurred.
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Affiliation(s)
| | - Katherine Riordan
- 1College of Medicine, The University of Arizona College of Medicine-Tucson
| | | | - Paul Bowlby
- 3Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, The University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | | | | | | | - Andrew Tang
- 3Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, The University of Arizona College of Medicine-Tucson, Tucson, Arizona
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Græsholt-Knudsen T, Rask CU, Lucas S, Bech BH. Exploratory assessment of parental physical disease categories as predictors of documented physical child abuse. Eur J Pediatr 2024; 183:663-675. [PMID: 37955746 PMCID: PMC10912441 DOI: 10.1007/s00431-023-05317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
Improved prediction of physical child abuse could aid in developing preventive measures. Parental physical disease has been tested previously as a predictor of documented physical child abuse but in broad categories and with differing results. No prior studies have tested clinically recognizable categories of parental disease in a high-powered dataset. Using Danish registries, data on children and their parents from the years 1997-2018 were used to explore several parental physical disease categories' associations with documented physical child abuse. For each disease category, survival analysis using pseudovalues was applied. When a parent of a child was diagnosed or received medication that qualified for a category, this family and five comparison families not in this disease category were included, creating separate cohorts for each category of disease. Multiple analyses used samples drawn from 2,705,770 children. Estimates were produced for 32 categories of physical diseases. Using Bonferroni-corrected confidence intervals (CIc), ischemic heart disease showed a relative risk (RR) of 1.44 (CIc 1.13-1.84); peripheral artery occlusive disease, RR 1.39 (CIc 1.01-1.90); stroke, RR 1.19 (1.01-1.41); chronic pulmonary disease, RR 1.33 (CIc 1.18-1.51); ulcer/chronic gastritis, RR 1.27 (CIc 1.08-1.49); painful condition, 1.17 (CIc 1.00-1.37); epilepsy, RR 1.24 (CIc 1.00-1.52); and unspecific somatic symptoms, RR 1.37 (CIc 1.21-1.55). Unspecific somatic symptoms were present in 71.87% of families at some point during the study period. CONCLUSION Most parental physical disease categories did not show statistically significant associations, but some showed predictive ability. Further research is needed to explore preventive potential. WHAT IS KNOWN • Few and broad categories of parental physical disease have been examined as risk factors for severe physical child abuse; no prior study has used several categories as predictors. WHAT IS NEW • Unspecific symptoms, ischemic heart disease, peripheral artery occlusive disease, stroke, chronic pulmonary disease, stomach ulcer/chronic gastritis, painful condition, and epilepsy all showed to be potential predictors, with unspecific symptoms being the most prevalent.
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Affiliation(s)
- Troels Græsholt-Knudsen
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus N, Denmark
| | - Steven Lucas
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Thomas H, Cromb D, Alcock A, Jacob H. Safeguarding essentials in modern-day paediatrics: inflicted injuries, body maps and section 47 investigations. Arch Dis Child Educ Pract Ed 2024; 109:25-28. [PMID: 38071544 DOI: 10.1136/archdischild-2023-326109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/19/2023] [Indexed: 01/25/2024]
Abstract
The second case in the Safeguarding Essentials in Modern-day Paediatrics series, this article focuses on inflicted injuries, body maps and child protection investigations (CPIs). Using the scenario of a 6-year-old presenting to the emergency department having 'fallen off a swing', this article focuses on key considerations for history taking and examination in cases where you suspect injuries may have been inflicted, and how to discuss raising these suspicions with the family, as well as the importance of accurate body map completion. Also covered are CPIs, giving consideration to the legal framework surrounding these, and relevant useful resources and guidance are provided for dealing with the challenging circumstances that arise when physical abuse is first suspected.
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Affiliation(s)
- Helen Thomas
- Paediatric Emergency Department, Evelina London Children's Hospital, London, UK
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London Faculty of Life Sciences & Medicine, London, UK
| | - Anastasia Alcock
- Paediatric Emergency Department, Evelina London Children's Hospital, London, UK
| | - Hannah Jacob
- Department of Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
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Steyn M, Brits D, Botha D, Holland S. Violence against children: A review of cases at a forensic anthropology unit, Johannesburg, South Africa. J Forensic Leg Med 2024; 101:102623. [PMID: 38043241 DOI: 10.1016/j.jflm.2023.102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
South Africa is experiencing a scourge of violence against women and children, with alarming levels of violence, and as such, juvenile cases are sometimes encountered in a forensic anthropological setting. The aim of this research was to assess the cases of juveniles (under 20 years) presenting at the Human Variation and Identification Research Unit (HVIRU) for a 6-year period (2016-2022), in order to assess patterns and types of cases referred. A total of 19 cases were assessed, of which 10 were 16-20 years old, 3 between the ages of 5 and 15 years and 6 less than 5 years old at the time of death. Of the 14 children with known sex, 12 were female with features suggesting that they fell prey to sexual violence. Many of the individuals were either known (and referred for trauma analysis) or identified following investigation. Of the 19 juveniles, 11 (58 %) had evidence of perimortem trauma (sharp and/or blunt), attesting to the violent nature of their deaths. Two cases had both sharp and blunt force trauma, of which one is a possible case of dismemberment. The remains of two individuals showed signs of perimortem burning, which may or may not be related to the cause of death. Three individuals had signs of antemortem (healed) trauma, which may suggest a longer period of abuse. Five of the individuals showed signs of disease - two had cribra orbitalia, while two others had various porous lesions indicative of chronic disease or malnutrition. One individual had advanced osteomyelitis, suggesting a natural cause of death. Some of these cases had unusual trauma and pathology, highlighting the contribution of forensic anthropologists.
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Affiliation(s)
- M Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - D Brits
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - D Botha
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - S Holland
- Department of Forensic Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Jadhav P, Sears T, Floan G, Joskowitz K, Nienow S, Cruz S, David M, de Cos V, Choi P, Ignacio RC. Application of a Machine Learning Algorithm in Prediction of Abusive Head Trauma in Children. J Pediatr Surg 2024; 59:80-85. [PMID: 37858394 DOI: 10.1016/j.jpedsurg.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE We explored the application of a machine learning algorithm for the timely detection of potential abusive head trauma (AHT) using the first free-text note of an encounter and demographic information. METHODS First free-text physician notes and demographic information were collected for children under 5 years of age at a Level 1 Trauma Center. The control group, which included patients with head/neck injury, was compared to those with AHT diagnosed by the Child Protective Team. Differential scores accounted for words overrepresented in AHT patient vs. control notes. Sentiment scores were reflective of note positivity/negativity and subjectivity scores accounted for note subjectivity/objectivity. The composite scores reflected the patient's differential score modified by the subjectivity score. Composite, sentiment, and subjectivity scores combined with demographic information trained a Random Forest (RF) machine learning algorithm to predict AHT. RESULTS Final composite scores with demographic information were highly associated with AHT in a test dataset. The control group included 587 patients and the test group included 193 patients. Combining composite scores with demographic information into the RF model improved AHT classification area under the curve (AUC) from 0.68 to 0.78, with an overall accuracy of 84%. Feature importance analysis of our RF model revealed that composite score, sentiment, age, and subjectivity were the most impactful predictors of AHT. The sentiment was not significantly different between control and AHT notes (p = 0.87), while subjectivity trended higher for AHT notes (p = 0.081). CONCLUSION We conclude that a machine learning algorithm can recognize patterns within free-text notes and demographic information that aid in AHT detection in children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Priyanka Jadhav
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Timothy Sears
- Department of Bioinformatics and Systems Biology Graduate Program, University of California San Diego, 9500 Gilman Drive, San Diego, CA, 92093, USA
| | - Gretchen Floan
- Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA, 92134, USA
| | - Katie Joskowitz
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA, 92123, USA
| | - Shalon Nienow
- Department of Pediatrics, Division of Child Abuse Pediatrics, University of California-San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA; Chadwick Center for Children and Families at Rady Childrens Hospital, 3665 Kearny Villa Road, Suite 500, San Diego, CA, 92123, USA
| | - Sheena Cruz
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Maya David
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Víctor de Cos
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Pam Choi
- Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA, 92134, USA
| | - Romeo C Ignacio
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA; Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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Zamalin D, Hamlin I, Shults J, Katherine Henry M, Campbell KA, Anderst JD, Bachim AN, Berger RP, Frasier LD, Harper NS, Letson MM, Melville JD, Lindberg DM, Wood JN. Predictors of Making a Referral to Child Protective Services Prior to Expert Consultation. Acad Pediatr 2024; 24:78-86. [PMID: 37178908 PMCID: PMC10638459 DOI: 10.1016/j.acap.2023.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Suspicion for child abuse is influenced by implicit biases. Evaluation by a Child Abuse Pediatrician (CAP) may reduce avoidable child protective services (CPS) referrals. Our objective was to investigate the association of patient demographic, social and clinical characteristics with CPS referral before consultation by a CAP (preconsultation referral). METHODS Children<5years-old undergoing in-person CAP consultation for suspected physical abuse from February 2021 through April 2022 were identified in CAPNET, a multicenter child abuse research network. Marginal standardization implemented with logistic regression analysis examined hospital-level variation and identified demographic, social, and clinical factors associated with preconsultation referral adjusting for CAP's final assessment of abuse likelihood. RESULTS Among the 61% (1005/1657) of cases with preconsultation referral, the CAP consultant had low concern for abuse in 38% (384/1005). Preconsultation referrals ranged from 25% to 78% of cases across 10 hospitals (P < .001). In multivariable analyses, preconsultation referral was associated with public insurance, caregiver history of CPS involvement, history of intimate partner violence, higher CAP level of concern for abuse, hospital transfer, and near-fatality (all P < .05). The difference in preconsultation referral prevalence for children with public versus private insurance was significant for children with low CAP concern for abuse (52% vs 38%) but not those with higher concern for abuse (73% vs 73%), (P = .023 for interaction of insurance and abuse likelihood category). There were no differences in preconsultation referral based on race or ethnicity. CONCLUSIONS Biases based on socioeconomic status and social factors may impact decisions to refer to CPS before CAP consultation.
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Affiliation(s)
- Danielle Zamalin
- Department of Pediatrics (D Zamalin), Kravis Children's Hospital, Icahn School of Medicine, Mount Sinai Hospital, New York, NY.
| | - Irene Hamlin
- Perelman School of Medicine (I Hamlin), University of Pennsylvania, Philadelphia, Pa.
| | - Justine Shults
- Department of Biostatistics, Epidemiology (J Shults), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
| | - M Katherine Henry
- Division of General Pediatrics, Clinical Futures, and PolicyLab (M Katherine Henry), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
| | - Kristine A Campbell
- Department of Pediatrics (KA Campbell), University of Utah, Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, Utah.
| | - James D Anderst
- Children's Mercy Kansas City (JD Anderst), University of Missouri Kansas City School of Medicine.
| | - Angela N Bachim
- Division of Public Health Pediatrics, Department of Pediatrics (AN Bachim), Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
| | - Rachel P Berger
- Department of Pediatrics (RP Berger), UPMC Children's Hospital of Pittsburgh, Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pa.
| | - Lori D Frasier
- Department of Pediatrics (LD Frasier), Penn State Children's Hospital, Penn State Hershey College of Medicine, Hershey, Pa; Penn State Hershey Medical Center (LD Frasier), Center for the Protection of Children, Hershey, Pa.
| | - Nancy S Harper
- University of Minnesota School of Medicine (NS Harper), Center for Safe and Healthy Children, Minneapolis, Minn.
| | - Megan M Letson
- Nationwide Children's Hospital (MM Letson), The Ohio State University College of Medicine, Columbus, Ohio.
| | - John D Melville
- Division of Child Abuse Pediatrics (JD Melville), Medical University of South Carolina, Charleston, SC.
| | - Daniel M Lindberg
- Department of Emergency Medicine (DM Lindberg), The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colo.
| | - Joanne N Wood
- Division of General Pediatrics and PolicyLab (JN Wood), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
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Shum M, Hsiao A, Teng W, Asnes A, Amrhein J, Tiyyagura G. Natural Language Processing - A Surveillance Stepping Stone to Identify Child Abuse. Acad Pediatr 2024; 24:92-96. [PMID: 37652162 PMCID: PMC10840716 DOI: 10.1016/j.acap.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE We aimed to refine a natural language processing (NLP) algorithm that identified injuries associated with child abuse and identify areas in which integration into a real-time clinical decision support (CDS) tool may improve clinical care. METHODS We applied an NLP algorithm in "silent mode" to all emergency department (ED) provider notes between July 2021 and December 2022 (n = 353) at 1 pediatric and 8 general EDs. We refined triggers for the NLP, assessed adherence to clinical guidelines, and evaluated disparities in degree of evaluation by examining associations between demographic variables and abuse evaluation or reporting to child protective services. RESULTS Seventy-three cases falsely triggered the NLP, often due to errors in interpreting linguistic context. We identified common false-positive scenarios and refined the algorithm to improve NLP specificity. Adherence to recommended evaluation standards for injuries defined by nationally accepted clinical guidelines was 63%. There were significant demographic differences in evaluation and reporting based on presenting ED type, insurance status, and race and ethnicity. CONCLUSIONS Analysis of an NLP algorithm in "silent mode" allowed for refinement of the algorithm and highlighted areas in which real-time CDS may help ED providers identify and pursue appropriate evaluation of injuries associated with child physical abuse.
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Affiliation(s)
- May Shum
- Department of Pediatrics (M Shum, A Hsiao, A Asnes, and G Tiyyagura), Yale University School of Medicine, New Haven, Conn.
| | - Allen Hsiao
- Department of Pediatrics (M Shum, A Hsiao, A Asnes, and G Tiyyagura), Yale University School of Medicine, New Haven, Conn
| | - Wei Teng
- Yale New Haven Hospital (W Teng), Joint Data Analytics Team, Conn
| | - Andrea Asnes
- Department of Pediatrics (M Shum, A Hsiao, A Asnes, and G Tiyyagura), Yale University School of Medicine, New Haven, Conn
| | - Joshua Amrhein
- 3M Health Information Systems (J Amrhein), Implementation/Adoption Services, Pittsburgh, Pa
| | - Gunjan Tiyyagura
- Department of Pediatrics (M Shum, A Hsiao, A Asnes, and G Tiyyagura), Yale University School of Medicine, New Haven, Conn
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Caldas SA, Murphy E, Habeshian K, Kirkorian AY, Hinds T. Ulcerated diaper dermatitis: Child abuse mimicker. Pediatr Dermatol 2024; 41:87-90. [PMID: 37329293 DOI: 10.1111/pde.15374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/19/2023] [Indexed: 06/19/2023]
Abstract
Irritant diaper dermatitis is a common dermatologic problem among infants and young children. Severe erosive presentations, although uncommon, are diagnostically challenging and can mimic non-accidental trauma (NAT). Diagnosing inflicted injury and NAT where it does not exist can cause parental distress, yet failing to diagnose inflicted injury and NAT can result in re-injury. We describe three cases of severe erosive diaper dermatitis in pediatric patients aged 2-6 years that were initially concerning for inflicted scald burn or neglect.
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Affiliation(s)
- Stella A Caldas
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Emily Murphy
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kaiane Habeshian
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Dermatology, Children's National Hospital, Washington, DC, USA
| | - Anna Yasmine Kirkorian
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Dermatology, Children's National Hospital, Washington, DC, USA
| | - Tanya Hinds
- Division of Child and Adolescent Protection, Children's National Hospital, Washington, DC, USA
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Bentz L, Mantilla DO, Winter SM. [Diagnostic Options for Suspected Cases of Emotional Maltreatment - Presentation of the Interdisciplinary Perspective of a Child Protection Outpatient Clinic]. Prax Kinderpsychol Kinderpsychiatr 2024; 73:55-84. [PMID: 38275233 DOI: 10.13109/prkk.2024.73.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Compared to sexual and physical violence, cases of emotional abuse are often more difficult to detect. An increasingly advocated approach involves regular assessments within social and healthcare structures tto proactively identify affected children and adolescents at an early stage. This enables the prompt initiation of appropriate interventions. Following, interdisciplinary institutions such as a child protection outpatient clinic can play an important role for professionals in the clarification of suspected child endangerment.This article aims to show possible courses of action for the early detection of emotional abuse based on a child protection outpatient clinic. In addition to the description of the interdisciplinary diagnostic procedure a selection of psychometric questionnaires and interviews is presented, which inquire about emotional abuse. When looking at the total number of 1,388 cases seen at the child protection outpatient clinic, it is noticeable that only 117 cases (8.4 %) were assigned with a suspicion of emotional abuse.This contrasts with 477 cases (34.3 %) in which confirmed indications for emotional abuse were found after the clarification process. An intersection of emotional abuse with other forms of child maltreatment was given in 341 cases (71.4 %). Psychometric questionnaires and interviews can facilitate a regular recording in health and social service institutions. Emotional abuse often goes unnoticed despite its frequency. Itsmanifestations are diverse and significantly overlap with other forms of maltreatment, necessitating a nuanced evaluation process. Specific diagnostic tools and interdisciplinary collaboration can contribute to better recognition of emotional abuse.
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Affiliation(s)
- Lea Bentz
- Lehrstuhl für Kinderschutz und Traumafolgen, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters Charité Universitätsmedizin Berlin, Campus Virchow Klinikum Augustenburger Platz 1 13353 Berlin Deutschland
| | - Diego Olaya Mantilla
- Lehrstuhl für Kinderschutz und Traumafolgen, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters Charité Universitätsmedizin Berlin, Campus Virchow Klinikum Augustenburger Platz 1 13353 Berlin Deutschland
| | - Sibylle M Winter
- Lehrstuhl für Kinderschutz und Traumafolgen, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters Charité Universitätsmedizin Berlin, Campus Virchow Klinikum Augustenburger Platz 1 13353 Berlin Deutschland
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45
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Bragança-Souza KK, Lopes de Lisboa J, Silva-Oliveira F, Soares Nunes L, Ferreira E Ferreira E, Gomes VE, Zarzar PMPDA. Health Professionals: Identifying and Reporting Child Physical Abuse-a Scoping Review. Trauma Violence Abuse 2024; 25:327-340. [PMID: 36747372 DOI: 10.1177/15248380221150949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Health professionals play a significant role in identifying and reporting child physical abuse (CPA). However, several studies have pointed out non-reporting behavior among these professionals, evidencing difficulties identifying and reporting suspected cases. This review aimed to explore the frequency and possible barriers in identifying and reporting CPA by health professionals worldwide and to identify associated factors. This scoping review was conducted in the Pubmed, Web Of Science, Scopus, and SciELO databases between July 2019 and December 2020. Analytical and qualitative observational epidemiological studies were selected and published in English, Portuguese, and Spanish, with data on the identification and/or reporting of CPA by health professionals. Twenty studies fulfilled the criteria of this review. The studies were conducted with dentists, nurses, pediatricians, and general practitioners. The frequency of identification of CPA ranged from 50% to 89%, while the frequency of reporting ranged from 8% to 47%. This review revealed that health professionals had a low frequency of reporting of CPA, especially for dentists. In addition, several associated factors and barriers in the identification and reporting of CPA were identified in the studies. These were discussed in five main themes: training and continuing education in CPA, impact on professional practice, experiences and perceptions about child protection services, the threshold for suspicion of the professional, and the professional category.
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46
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Scanvion Q, Delteil C, Le Garff E, Cornez R, Hédouin V. A sudden death, an aortic rupture, and an unexpected cause: a report about suspected child abuse. Int J Legal Med 2024; 138:301-306. [PMID: 36773089 DOI: 10.1007/s00414-023-02963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
All unexpected deaths of children require an autopsy to determine the cause of death. In cases of aortic rupture, the immediate cause of death is easily identified at autopsy. Although the majority of aortic ruptures are caused by high-energy trauma, other causes should not be missed.We present and discuss the case of a 29-month-old child who died suddenly at home. Her recent medical history and the ecchymotic lesions observed on external examination of the body appeared potentially suspicious of physical abuse. The autopsy concluded that death was due to complete rupture of the abdominal aorta with associated vertebral disjunction. At first glance, the overall forensic picture could suggest a traumatic death. However, careful inspection of the retroperitoneum revealed a discrete atypical mass of infiltrative tissue within the hematoma. Histopathological examinations confirmed tumor proliferation of the soft tissues, triggering vascular and spinal injuries. Other paraneoplastic elements or metastases were ultimately revealed (orbital and subcutaneous). Overall, this was a rare and fatal case of abdominal aortic rupture induced by tumors. Due to the mechanisms and the forces needed to cause vertebral dislocations and aortic rupture, the combination of the two is highly suggestive of child abuse when an accidental traumatic history is absent or inconsistent with the injuries. Nevertheless, this case illustrates the importance of a systematic and rigorous forensic examination, rather than ignoring other possible diagnoses.
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Affiliation(s)
- Quentin Scanvion
- Univ. Lille, ULR 7367 Unité de Taphonomie Médico-Légale & Anatomie, F-59000, Lille, France.
- CHU de Lille, Institut Médico-Légal, 59000, Lille, France.
| | - Clémence Delteil
- Service de Médecine Légale Et Droit de La Santé, APHM, La Timone, 13385, Marseille, France
| | - Erwan Le Garff
- CH de Boulogne-Sur-Mer, Unité Médico-Judiciaire, 62200, Boulogne-Sur-Mer, France
| | - Raphaël Cornez
- CHU de Lille, Institut Médico-Légal, 59000, Lille, France
| | - Valéry Hédouin
- Univ. Lille, ULR 7367 Unité de Taphonomie Médico-Légale & Anatomie, F-59000, Lille, France
- CHU de Lille, Institut Médico-Légal, 59000, Lille, France
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47
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Kachelski C, Gavin K, Head H, Horton D, Anderst J. A lucid interval in a victim of abusive head trauma with multiple parenchymal lacerations. J Forensic Leg Med 2024; 101:102638. [PMID: 38185064 DOI: 10.1016/j.jflm.2023.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
Abusive head trauma (AHT) is a leading cause of abusive deaths in children under age one. AHT can include intracranial hemorrhages, hypoxic ischemic injury, or parenchymal lacerations. Most infants with parenchymal lacerations present with acute neurological symptoms. There has been some published literature on lucid intervals in cases of AHT; however, there has not been a described lucid interval with parenchymal lacerations. Parenchymal lacerations typically present with acute symptomatology such as seizures, alteration in mental status, or increased fussiness/lethargy given the damage to neurons and brain structure. We present a case of a healthy 2-month-old who ultimately was diagnosed with AHT and three parenchymal lacerations and had a 2.5 hour period of normal neurological status prior to acute decompensation.
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Affiliation(s)
- Cree Kachelski
- Division of Emergency Medicine, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Center for Safe and Healthy Children and Adolescents, Mayo Clinic, Rochester, MN, USA.
| | - Kelsey Gavin
- Graduate Medical Education, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Hayden Head
- Division of Radiology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Danielle Horton
- Division of Child Adversity and Resilience, Children's Mercy Kansas City, Kansas City, MO, USA
| | - James Anderst
- Division of Child Adversity and Resilience, Children's Mercy Kansas City, Kansas City, MO, USA
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48
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Eg MB, Graesholt-Knudsen T, Madsen KB, Obel C, Charles AV, Ingemann-Hansen O. Distinct age-related differences among victims in cases of suspected child abuse. J Forensic Sci 2024; 69:252-263. [PMID: 37792506 DOI: 10.1111/1556-4029.15398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Abstract
Evidence describing age-related differences among children with suspected physical and sexual child abuse is lacking. We describe findings in severe cases of suspected abuse. Cases with 756 children <15 years old were included during 2001-2013 at the Department of Forensic Medicine, Aarhus University, using forensic evaluation documents, medical records, and court proceedings. Eight percent of children <4 years old died from child abuse, 36% through violence resulting in death, and 64% by manslaughter, whereas 1% > 4 years old died, solely by manslaughter. External injuries were mainly located to head and torso in children <4 years old, changing to the upper and lower extremities in older children. Child sexual abuse was suspected in 52% of cases with living children <4 years old, 83% of children 4-7 years of age, 88% of children 8-11 years of age, and 93% of children >12 years old. Anogenital findings were mainly caused by other medical conditions in children <4 years old, hymenal clefts in the superior half of the hymenal rim were almost exclusively found in children between 8 and 11 years of age, whereas both superficial and complete hymenal clefts in the inferior half of the hymenal rim were found in children >12 years old. The present study describes age-related differences in victims of suspected child abuse. Fatal versus nonfatal child physical abuse and the significance of hymenal findings in child sexual abuse could be studied further.
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Affiliation(s)
- Marlene Beyer Eg
- Department of Forensic Medicine, Aarhus University, Aarhus N, Denmark
| | | | - Kathrine Bang Madsen
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus V, Denmark
| | - Carsten Obel
- Department of Public Health, Aarhus University, Aarhus C, Denmark
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49
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Hoffmann F, Heim C. [Emotional Abuse in Childhood and Adolescence: Biological Embedding and Clinical Implications]. Prax Kinderpsychol Kinderpsychiatr 2024; 73:4-27. [PMID: 38275227 DOI: 10.13109/prkk.2024.73.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Emotional abuse, defined as degrading, manipulative, or neglectful behaviors by caregivers, represents a common adverse experience for children and adolescents, often co-occurring with other maltreatment types. Exposure to emotional abuse significantly affects mental health across the lifespan and is particularly associated with elevated depression risk.This review examinesmechanisms, by which emotional abuse influences brain development and the neuroendocrine stress response system and discusses the roles of genetic vulnerability and epigenetic processes in contributing to an elevated mental health risk. Emotional abuse has similar effects on brain networks responsible for emotion processing and regulation as other maltreatment types.Moreover, it uniquely affects networks related to self-relevant information and socio-cognitive processes. Furthermore, emotional abuse is associated with an impaired recovery of the neuroendocrine response to acute stress. Similar to other maltreatment types, emotional abuse is associated with epigenetic changes in genes regulating the neuroendocrine stress response system that are implicated in increased mental health risk.These findings suggest that emotional abuse has equally detrimental effects on children'smental health as physical or sexual abuse, warranting broader societal awareness and enhanced early detection efforts. Early interventions should prioritize emotion regulation, social cognition, self-esteemenhancement, and relationship- oriented approaches for victims of emotional abuse.
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Affiliation(s)
- Ferdinand Hoffmann
- Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Institut für Medizinische Psychologie Deutschland
| | - Christine Heim
- Institut für Medizinische Psychologie Charité - Universitätsmedizin Berlin Luisenstr. 57 10117 Berlin Deutschland
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50
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Græsholt-Knudsen T, Rask CU, Lucas S, Obel C, Bech BH. Parental physical disease severity and severe documented physical child abuse: a prospective cohort study. Eur J Pediatr 2024; 183:357-369. [PMID: 37889291 PMCID: PMC10857964 DOI: 10.1007/s00431-023-05291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Abstract
Successful prevention of physical child abuse is dependent on improvements in risk assessment. The risk of abuse is assumed to increase when family stressors overcome resources. Severe physical disease can increase stress, and parental physical disease has been studied as a risk factor for physical child abuse, but with heterogeneous definitions. This study evaluated the relation between parental physical disease severity and severe documented physical child abuse. Models were based on data on children aged 0-17 years in Denmark between 1997 and 2018, and their parents. Severe documented physical child abuse was modeled as violence against a child registered by either health authorities in treatment or mortality registries, or police authorities in cases confirmed by the courts. Parental physical disease severity was modeled as the sum of Charlson Comorbidity Index scores for the child's parents. The causal connection was examined in two model types: a survival model comparing exposed with non-exposed children, adjusted for covariates at baseline, and a G-model, taking time-varying covariates, including income and parental psychiatric disease into account. Neither model showed an association between parental physical disease severity and severe documented physical child abuse, with RR 0.99 and 95% CI (0.93-1.05) for the survival model and RR 1.08 for the G-model (CI not calculated). Conclusion: In the model studied, parental physical disease severity was not a risk factor for severe documented physical child abuse. Individual categories of physical disease remain to be examined. Trial registration: The study was pre-registered on Open Science Framework, https://osf.io/fh2sr . What is Known: • Parental physical disease severity has been studied previously as a risk indicator of physical child abuse, but based on heterogeneous definitions. • Previous studies have not studied parental physical disease severity preceding physical child abuse. What is New: • Parental severe physical disease was not prospectively associated with severe documented physical child abuse in a survival model, a G-model and a number of sensitivity analyses, respectively. • Results should be replicated in samples from populations without universal health care, and using different categories of disease.
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Affiliation(s)
- Troels Græsholt-Knudsen
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark.
- Department of Forensic Medicine, Palle Juul-Jensens Boulevard 99, Aarhus University, 8200, Aarhus N, Aaurhus, Denmark.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, 8200, Aarhus N, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus N, Aarhus, Denmark
| | - Steven Lucas
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Carsten Obel
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark
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