ABSTRACT
BACKGROUND AND PURPOSE: Accurate differentiation of abusive head trauma and accidental head injury in infants and young children is critical and impacts clinical care, patient prognosis, forensic investigations, and medicolegal proceedings. No specific finding seen on cross-sectional brain imaging has been reported to distinguish abusive head trauma from accidental injury. Our study investigated whether a specific imaging finding, parenchymal brain laceration, is unique to children diagnosed with abusive head trauma. MATERIALS AND METHODS: We retrospectively identified 137 patients with abusive head trauma and 28 patients who incurred moderate to severe accidental brain injury. Brain MR imaging represented the imaging standard for characterizing intracranial injuries. RESULTS: Among the abusive head trauma cohort, parenchymal brain lacerations were identified in 18 patients, while none were identified in any patients with accidental injury. CONCLUSIONS: Our findings are in concurrence with the existing forensic, pathology, and imaging literature, which suggests that parenchymal brain lacerations may be related to abusive injury mechanisms.
Subject(s)
Accidents , Brain Injuries/diagnosis , Child Abuse/diagnosis , Craniocerebral Trauma/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Child , Child, Preschool , Cohort Studies , Cross-Sectional Studies , Diagnosis, Differential , Female , Humans , Infant , Infant, Newborn , Male , Prognosis , Retrospective StudiesABSTRACT
Unexplained SDH in infants and children is an accepted marker for AHT. It has been proposed that IVT may be the initiating event leading to the development of acute SDH, mimicking the appearance of traumatic SDH. Our study aims to investigate if nontraumatic IVT causes SDH in the pediatric population. We retrospectively identified 36 patients with IVT and reviewed neuroimaging studies for the concurrent presence of SDH. In our 36 patients with IVT, no associated SDH was observed. Even with extensive IVT, no SDH was present. Three false-positive diagnoses of IVT were identified in the setting of mastoiditis and traumatic SDH, demonstrating pitfalls in imaging. In conclusion, our findings do not support the previous AHT literature stating that IVT is associated with, or leads to, SDH in neonates, infants, or children.
Subject(s)
Cerebral Angiography/statistics & numerical data , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/epidemiology , Hematoma, Subdural/diagnostic imaging , Hematoma, Subdural/epidemiology , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/epidemiology , Causality , Child , Child, Preschool , Comorbidity , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Risk Assessment , Utah/epidemiology , Young AdultABSTRACT
The history of sexual abuse that a child gives to the pediatrician may be the single most important factor in determining if a child has been abused. Most children have completely normal anogenital examinations; very rarely is definitive forensic evidence obtained or a sexually transmitted disease discovered. Physicians, in general, are given unique authority and privilege in reporting such hearsay evidence. The pediatrician often is the first professional with whom a child has contact when an allegation of abuse is made. Child protective issues then become paramount. It is important, therefore, for the physician to have the basic skills and knowledge of the developmentally appropriate approach to interviewing a child. How that interview is preserved and documented is also critically important and will be scrutinized in any legal proceedings. The physician's interview should not replace a skilled forensic interview but be considered a supplement, whose purpose is foremost the health, well-being, and protection of the child.
Subject(s)
Child Abuse, Sexual/diagnosis , Medical History Taking/methods , Pediatrics/methods , Physician's Role , Physician-Patient Relations , Adolescent , Case Management , Child , Child Abuse, Sexual/legislation & jurisprudence , Developmental Disabilities/complications , Documentation , Humans , Professional-Family RelationsABSTRACT
Evaluation of anogenital lesions in children is a challenging problem. The differential diagnosis includes a spectrum of traumatic, infectious, neoplastic, and genetic disorders. The possibility of sexual abuse should always be considered and investigated as indicated. A systematic work-up will expedite the correct diagnosis and limit unnecessary anxiety for parents, children, and physicians. Referral to a center that provides specialized service for the evaluation and treatment of these disorders may be indicated.
Subject(s)
Anus Diseases/pathology , Genital Diseases, Male/pathology , Skin Diseases/pathology , Vulvar Diseases/pathology , Adolescent , Anus Diseases/etiology , Child , Child, Preschool , Diagnosis, Differential , Female , Genital Diseases, Male/etiology , Humans , Infant , Male , Sexually Transmitted Diseases/etiology , Sexually Transmitted Diseases/pathology , Skin Diseases/etiology , Vulva/injuries , Vulvar Diseases/etiologyABSTRACT
Evaluation and treatment of pediatric condylomata acuminata are challenging problems. Careful and thorough evaluation for the possibility of sexual abuse is mandatory in all cases. New molecular techniques of HPV DNA detection and typing have not proved helpful in determining the source of the infection but may assist in identifying children who are at risk for the development of carcinoma. Ideal therapy does not exist; non-intervention may be the most appropriate choice for the majority of patients who carry low-risk viral types. Many unanswered questions remain regarding the biology and epidemiology of HPV in children and adults. Clinical and basic science research specifically designed to address the concerns of the pediatric age group is urgently needed.
Subject(s)
Anus Diseases , Condylomata Acuminata , Genital Diseases, Female , Genital Diseases, Male , Adult , Anus Diseases/diagnosis , Anus Diseases/pathology , Anus Diseases/therapy , Child , Child Abuse, Sexual/diagnosis , Condylomata Acuminata/diagnosis , Condylomata Acuminata/pathology , Condylomata Acuminata/therapy , Cryotherapy , Diagnosis, Differential , Female , Genital Diseases, Female/diagnosis , Genital Diseases, Female/pathology , Genital Diseases, Female/therapy , Genital Diseases, Male/diagnosis , Genital Diseases, Male/pathology , Genital Diseases, Male/therapy , Humans , Immunotherapy , Infant , Infectious Disease Transmission, Vertical , Laser Coagulation , Male , PhotochemotherapyABSTRACT
Human papillomavirus infections in children, particularly when occurring as condylomata acuminata, present a difficult and often puzzling problem. The possibility that the lesions were acquired through sexual contact mandates a careful and thorough evaluation. Even then, the source of the infection may be elusive because of a long latency between inoculation and the development of lesions, the secretive milieu of childhood sexual abuse, and lack of data about modes of transmission. New molecular techniques of HPV DNA detection and typing have not proven to be helpful in determining the source of the infection but may assist in identifying children who are at risk for the development of carcinoma. Various treatment modalities have been attempted with a significant percentage of recurrences. Many unanswered questions remain regarding the biology and epidemiology of HPV in children and adults. Clinical and basic science research specifically designed to address the concerns of the pediatric age group is urgently needed.
