Pediatrics. 2013 Apr;131(4):e1314-22. doi: 10.1542/peds.2013-0195. Epub 2013 Mar 25.
Bruising or bleeding in a child can raise the concern for child abuse. Assessing whether the findings are the result of trauma and/or whether the child has a bleeding disorder is critical. Many bleeding disorders are rare, and not every child with bruising/bleeding concerning for abuse requires an evaluation for bleeding disorders. In some instances, however, bleeding disorders can present in a manner similar to child abuse. The history and clinical evaluation can be used to determine the necessity of an evaluation for a possible bleeding disorder, and prevalence and known clinical presentations of individual bleeding disorders can be used to guide the extent of the laboratory testing. This clinical report provides guidance to pediatricians and other clinicians regarding the evaluation for bleeding disorders when child abuse is suspected.
儿童瘀伤或出血可能会引起人们对虐待儿童的关注。评估这些发现是外伤所致还是儿童存在出血性疾病至关重要。许多出血性疾病较为罕见,并非所有因虐待而出现瘀伤/出血的儿童都需要评估出血性疾病。然而,在某些情况下,出血性疾病的表现可能类似于虐待儿童。病史和临床评估可用于确定是否需要评估可能存在的出血性疾病,而个别出血性疾病的患病率和已知临床表现可用于指导实验室检查的范围。本临床报告就怀疑虐待儿童时如何评估出血性疾病为儿科医生和其他临床医生提供了指导。