Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Department of Pediatrics, Seattle Children's Hospital & University of Washington, Seattle, Washington.
J Emerg Med. 2021 Aug;61(2):198-204. doi: 10.1016/j.jemermed.2021.02.018. Epub 2021 Mar 29.
Bruising in an infant is an important sentinel injury that should raise concern for child physical abuse, and should prompt a medical evaluation for occult injury. Hyperflexion during forceful squeezing of an infant's hand results in a distinct pattern of bruising along the palmar and interdigital creases, as well as the palmar eminences. Self-inflicted injury by the infant or injury resulting from benign handling should not be accepted as plausible explanations for this injury. The presence of concurrent occult injuries is common, and further supports concerns for abuse. However, when this distinct pattern of palm bruising is identified in an infant, the absence of occult injuries should not prevent the recognition of child physical abuse.
We report 11 cases depicting this distinct pattern of palm bruising in infants. Additionally, we include a perpetrator's documented confession. To the best of our knowledge, this pattern of bruising has not been previously described in the medical literature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians play a crucial role in recognizing and addressing child physical abuse. Prompt recognition of this finding can aid in the identification of child physical abuse, even in the absence of underlying occult injury. This, in turn, can potentially prevent further injury, and even death, of an infant.
婴儿瘀伤是一种重要的警示性损伤，应引起人们对儿童身体虐待的关注，并应促使对隐匿性损伤进行医学评估。在用力挤压婴儿手时的过度弯曲会导致手掌和指间皱褶以及手掌隆起处出现明显的瘀伤模式。婴儿的自我伤害或因良性处理而导致的损伤不应被视为这种损伤的合理解释。隐匿性损伤的同时存在很常见，进一步支持了虐待的担忧。然而，当在婴儿中发现这种独特的手掌瘀伤模式时，隐匿性损伤的缺失不应阻止对儿童身体虐待的识别。
我们报告了 11 例描绘了这种独特的手掌瘀伤模式的婴儿病例。此外，我们还包括肇事者的书面供词。据我们所知，这种瘀伤模式以前在医学文献中没有描述过。
为什么急诊医生应该注意到这一点？：急诊医生在识别和处理儿童身体虐待方面发挥着至关重要的作用。及时识别这一发现有助于识别儿童身体虐待，即使没有潜在的隐匿性损伤。这反过来又可以防止婴儿进一步受伤，甚至死亡。
