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American Academy of Pediatrics
Article

Sentinel Injuries in Infants Evaluated for Child Physical Abuse

Lynn K. Sheets, Matthew E. Leach, Ian J. Koszewski, Ashley M. Lessmeier, Melodee Nugent and Pippa Simpson
Pediatrics April 2013, 131 (4) 701-707; DOI: https://doi.org/10.1542/peds.2012-2780
Lynn K. Sheets
aMedical College of Wisconsin, Milwaukee, Wisconsin;
bChildren’s Hospital of Wisconsin, Milwaukee, Wisconsin;
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Matthew E. Leach
cSt Louis University School of Medicine, St Louis, Missouri; and
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Ian J. Koszewski
dUniversity of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Ashley M. Lessmeier
aMedical College of Wisconsin, Milwaukee, Wisconsin;
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Melodee Nugent
aMedical College of Wisconsin, Milwaukee, Wisconsin;
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Pippa Simpson
aMedical College of Wisconsin, Milwaukee, Wisconsin;
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Abstract

OBJECTIVE: Relatively minor abusive injuries can precede severe physical abuse in infants. Our objective was to determine how often abused infants have a previous history of “sentinel” injuries, compared with infants who were not abused.

METHODS: Case-control, retrospective study of 401, <12-month-old infants evaluated for abuse in a hospital-based setting and found to have definite, intermediate concern for, or no abuse after evaluation by the hospital-based Child Protection Team. A sentinel injury was defined as a previous injury reported in the medical history that was suspicious for abuse because the infant could not cruise, or the explanation was implausible.

RESULTS: Of the 200 definitely abused infants, 27.5% had a previous sentinel injury compared with 8% of the 100 infants with intermediate concern for abuse (odds ratio: 4.4, 95% confidence interval: 2.0–9.6; P < .001). None of the 101 nonabused infants (controls) had a previous sentinel injury (P < .001). The type of sentinel injury in the definitely abused cohort was bruising (80%), intraoral injury (11%), and other injury (7%). Sentinel injuries occurred in early infancy: 66% at <3 months of age and 95% at or before the age of 7 months. Medical providers were reportedly aware of the sentinel injury in 41.9% of cases.

CONCLUSIONS: Previous sentinel injuries are common in infants with severe physical abuse and rare in infants evaluated for abuse and found to not be abused. Detection of sentinel injuries with appropriate interventions could prevent many cases of abuse.

  • abuse
  • bruising
  • infants
  • maltreatment
  • screening
  • abusive head trauma
  • Abbreviations:
    AHT —
    abusive head trauma
    CHW —
    Children’s Hospital of Wisconsin
    CPT —
    Child Protection Team
    • Accepted December 11, 2012.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 4
    1 Apr 2013
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    Sentinel Injuries in Infants Evaluated for Child Physical Abuse
    Lynn K. Sheets, Matthew E. Leach, Ian J. Koszewski, Ashley M. Lessmeier, Melodee Nugent, Pippa Simpson
    Pediatrics Apr 2013, 131 (4) 701-707; DOI: 10.1542/peds.2012-2780

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    Sentinel Injuries in Infants Evaluated for Child Physical Abuse
    Lynn K. Sheets, Matthew E. Leach, Ian J. Koszewski, Ashley M. Lessmeier, Melodee Nugent, Pippa Simpson
    Pediatrics Apr 2013, 131 (4) 701-707; DOI: 10.1542/peds.2012-2780
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    • Potential Opportunities for Prevention or Earlier Diagnosis of Child Physical Abuse in the Inpatient Setting
    • Bruising characteristics from unintentional injuries in children: the 'green flag study
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    • Oral and Dental Aspects of Child Abuse and Neglect
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    • Bruising in Infants Presenting to Pediatric EDs
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    • Bruising Patterns in Young Children
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    Subjects

    • Injury, Violence & Poison Prevention
      • Injury, Violence & Poison Prevention
    • Child Abuse and Neglect
      • Child Abuse and Neglect

    Keywords

    • abuse
    • bruising
    • infants
    • maltreatment
    • screening
    • abusive head trauma
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