Children's Physician Services of South Texas, Driscoll Children's Hospital, Corpus Christi, TX.
Children's Protection Program, Odessa Brown Children's Clinic, Seattle Children's Hospital, University of Washington.
J Pediatr. 2014 Aug;165(2):383-388.e1. doi: 10.1016/j.jpeds.2014.04.004. Epub 2014 May 17.
To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising.
This was a prospectively planned secondary analysis of an observational study of children<10 years (120 months) of age evaluated for possible physical abuse by 20 US child abuse teams. This analysis included infants<6 months of age with apparently isolated bruising who underwent diagnostic testing for additional injuries or bleeding disorders.
Among 2890 children, 33.9% (980/2890) were <6 months old, and 25.9% (254/980) of these had bruises identified. Within this group, 57.5% (146/254) had apparently isolated bruises at presentation. Skeletal surveys identified new injury in 23.3% (34/146), neuroimaging identified new injury in 27.4% (40/146), and abdominal injury was identified in 2.7% (4/146). Overall, 50% (73/146) had at least one additional serious injury. Although testing for bleeding disorders was performed in 70.5% (103/146), no bleeding disorders were identified. Ultimately, 50% (73/146) had a high perceived likelihood of abuse.
Infants younger than 6 months of age with bruising prompting subspecialty consultation for abuse have a high risk of additional serious injuries. Routine medical evaluation for young infants with bruises and concern for physical abuse should include physical examination, skeletal survey, neuroimaging, and abdominal injury screening.
在因明显孤立性瘀伤而接受虐待评估的大量婴幼儿人群中，确定是否存在其他损伤或出血性疾病。
这是对 20 个美国儿童虐待小组评估的疑似身体虐待的<10 岁（120 个月）儿童进行观察性研究的前瞻性计划二次分析。该分析包括<6 个月龄、有明显孤立性瘀伤且接受其他损伤或出血性疾病诊断性检查的婴儿。
在 2890 名儿童中，33.9%（2890/980）<6 个月，其中 25.9%（254/980）有瘀伤。在这一组中，57.5%（146/254）在就诊时表现为明显孤立性瘀伤。骨骼扫描发现新损伤 23.3%（34/146），神经影像学发现新损伤 27.4%（40/146），腹部损伤 2.7%（4/146）。总体而言，50%（73/146）至少有一个额外的严重损伤。尽管对 70.5%（103/146）进行了出血性疾病检测，但未发现出血性疾病。最终，50%（73/146）被认为高度怀疑虐待。
因瘀伤而接受虐待专科会诊的<6 个月龄婴儿有发生其他严重损伤的高风险。对有瘀伤且疑似遭受身体虐待的婴幼儿进行常规医学评估应包括体格检查、骨骼扫描、神经影像学和腹部损伤筛查。
