Current Weight Status of Sexually Assaulted Pediatric Female Patients in an Emergency Department Setting.

Background: The relationship between childhood sexual abuse (CSA) and childhood obesity (CO) is unclear with studies reporting conflicting results in female populations. This study aims to assess the association between suspected CSA and current emergency department (ED) weight status when compared with trauma patients. Methods: This is a single-center retrospective case-control study that utilized pediatric ED data (2016-2018) from identified female patients (6-17 years old) with a chief complaint of sexual assault and trauma registry patients. Focus was on female patients for literary comparisons. Two weight measurements were calculated based on available height data: BMI-for-age and weight-for-age. Nonparametric testing and binary logistic regression were utilized. Results: There were 2044 study participants: 1454 (71.1%) cases and 590 (28.9%) controls. Cases were older, underrepresented minorities (URMs), and carried public insurance (all p-values <0.001). Using BMI-for-age, patients with a sexual assault complaint had a 67% increased odds for CO after adjusting for age, URM status, and insurance type [adjusted odds ratio (aOR) = 1.67 (95% confidence intervals [CIs] 1.07-2.62); p-value = 0.03], whereas the weight-for-age metric increased the aOR odds by 58% [aOR = 1.58 (95% CI 1.14-2.17); p-value = 0.01] when compared with pediatric trauma patients. Similar results were found in a sensitivity analysis using patients matched on age and URM. Conclusion: Our data demonstrated an association between suspected CSA and CO. More research is needed to identify the biopsychosocial implications for this relationship and the potential to augment clinical care.

Timely recognition of retinal hemorrhage in pediatric abusive head trauma evaluation.

BACKGROUND: Distinct patterns of retinal hemorrhages (RHs) are suggestive of abusive head trauma in the context of unexplained intracranial injury. Current recommendations encourage an eye examination within 48 hours of admission due to the rapid resolution of RH. The purpose of this study was to identify clinical factors associated with a delay in funduscopic examination outside the recommended 48 hours. METHODS: Retrospective chart review was completed on all inpatient consultations by the Child Protection Team with evidence of intracranial injury on computed tomography or magnetic resonance imaging over 3 years at a large children's hospital. Extracted data included demographic characteristics, history of intubation, pediatric intensive care unit (PICU) admission, extraventricular drain placement, seizures, use of vasopressor support, and presence of other injuries. Descriptive statistics were used to describe the patient population, clinical characteristics, and outcomes. Multivariate logistic regression was used to identify factors associated with delayed eye examinations. RESULTS: A total of 203 patients met inclusion criteria. Of those, 39 (19.2%) had a delay in initial funduscopic examination. Multivariate analyses revealed that PICU admission, surgical intervention, and seizure activity were significant predictors of delayed examination after controlling for multiple clinical factors. Neurosurgical consultation was shown to be protective against a delayed examination. CONCLUSIONS: Rapid resolution of RH may occur in child abuse. Prompt ophthalmology examinations and neurosurgery consultation when child abuse is suspected help avoid a delay in diagnosis.