Melville John D, Hertz Stephanie K, Steiner R Daryl, Lindberg Daniel M
Akron Children's Hospital.
CARE Center, Akron Children's Hospital, Akron, OH.
Pediatr Emerg Care. 2019 Apr;35(4):245-248. doi: 10.1097/PEC.0000000000001096.
Physicians are occasionally asked to evaluate children who are reported to have been victims of witnessed abuse, but who have no injuries noted on examination. The rate of injury in these patients is presently unknown. This is important because abuse allegations are brought for both altruistic and other reasons. This study compares the use of skeletal survey and neuroimaging in well-appearing and clearly injured children reported to be victims of witnessed child abuse.
Retrospectively planned secondary analysis of the Examination of Siblings to Recognize Abuse cohort of children referred to a child abuse pediatrician with concerns for physical abuse. Children were selected who presented to a medical provider with a history of witnessed child abuse including shaking. Rates of radiographically evident injuries are noted among children with and without injuries noted on physical examination.
Among 2890 children evaluated by a child abuse pediatrician, 90 children (3.1%) presented with a history of witnessed abuse. Among these, 51 children (57%) had injuries noted on physical examination; 9 (29%) of 31 skeletal surveys and 9 (35%) of 26 neuroimaging studies revealed injuries. Of 39 children (43%) with witnessed abuse and normal examination, 3 (10%) of 30 skeletal surveys and 2 (8%) of 25 neuroimaging studies revealed an injury.
A significant minority of children evaluated for allegations of witnessed abuse will have occult injuries identified radiographically. Absence of injury on examination should not deter physicians from obtaining otherwise indicated skeletal surveys and neuroimaging in children reported to have experienced witnessed abuse.
医生偶尔会被要求对那些据报告曾遭受目睹虐待的儿童进行评估，但体格检查时却未发现损伤。目前尚不清楚这些患儿的损伤发生率。这一点很重要，因为提出虐待指控可能是出于利他或其他原因。本研究比较了骨骼检查和神经影像学检查在那些外表正常且明显受伤、据报告曾遭受目睹儿童虐待的儿童中的应用情况。
对转诊至儿童虐待儿科医生处、因身体虐待问题而受到关注的“兄弟姐妹虐待识别检查”队列儿童进行回顾性计划二次分析。选取那些有目睹儿童虐待（包括摇晃）病史并就诊于医疗服务提供者的儿童。记录在体格检查时有或无损伤的儿童中影像学明显损伤的发生率。
在由儿童虐待儿科医生评估的2890名儿童中，90名儿童（3.1%）有目睹虐待病史；其中，51名儿童（57%）在体格检查时有损伤；31次骨骼检查中有9次（29%）、26次神经影像学检查中有9次（35%）发现损伤。在39名有目睹虐待且体格检查正常的儿童（43%）中，30次骨骼检查中有3次（10%）、25次神经影像学检查中有2次（8%）发现损伤。
在因目睹虐待指控而接受评估的儿童中，有相当少数会通过影像学检查发现隐匿性损伤。体格检查未发现损伤不应阻止医生对报告曾遭受目睹虐待的儿童进行必要的骨骼检查和神经影像学检查。
