Henry M Katherine, Wood Joanne N
Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Radiol. 2021 May;51(6):861-865. doi: 10.1007/s00247-020-04915-7. Epub 2021 May 17.
Infants are at greatest risk of severe and fatal physical abuse yet they sometimes present for medical care multiple times with abusive injuries prior to being diagnosed with abuse and having protective actions taken. Efforts to identify these infants in a timely manner are critical to prevent repeated, escalating abuse and subsequent harm. Increasing the identification and evaluation of sentinel injuries has been highlighted as a strategy for improving timely detection of abuse in infants. Sentinel injuries are visible, minor, poorly explained injuries in young infants that raise concern for abuse. These injuries include cutaneous injuries such as bruising, subconjunctival hemorrhages and intra-oral injuries. Sentinel injuries can signal concurrent clinically occult but more serious injuries or precede more significant trauma from abuse. As such, sentinel injuries offer an opportunity to intervene and protect infants from further harm. A thorough physical exam is critical for detecting sentinel injuries. Imaging with skeletal survey and, when appropriate, neuroimaging are key components of the medical evaluation of sentinel injuries in these high-risk infants.
婴儿遭受严重和致命身体虐待的风险最大，但在被诊断为受虐并采取保护措施之前，他们有时会因受虐伤害多次就医。及时识别这些婴儿对于防止反复、升级的虐待及后续伤害至关重要。加强对警示性损伤的识别和评估已被视为改善婴儿虐待及时发现的一项策略。警示性损伤是指在幼儿身上可见的、轻微的、难以解释的损伤，这些损伤会引发对虐待的担忧。这些损伤包括皮肤损伤，如瘀伤、结膜下出血和口腔内损伤。警示性损伤可能预示着同时存在临床上隐匿但更严重的损伤，或者在遭受更严重的虐待创伤之前出现。因此，警示性损伤为进行干预并保护婴儿免受进一步伤害提供了契机。全面的体格检查对于发现警示性损伤至关重要。骨骼检查成像以及在适当情况下的神经成像，是对这些高危婴儿警示性损伤进行医学评估的关键组成部分。
