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American Academy of Pediatrics
Article

Testing for Abuse in Children With Sentinel Injuries

Daniel M. Lindberg, Brenda Beaty, Elizabeth Juarez-Colunga, Joanne N. Wood and Desmond K. Runyan
Pediatrics October 2015, peds.2015-1487; DOI: https://doi.org/10.1542/peds.2015-1487
Daniel M. Lindberg
aKempe Center for the Prevention and Treatment of Child Abuse and Neglect, Denver, Colorado;
bDepartment of Emergency Medicine, School of Medicine, and
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Brenda Beaty
cAdult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Denver Colorado;
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Elizabeth Juarez-Colunga
cAdult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Denver Colorado;
dDepartment of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado; and
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Joanne N. Wood
eChildren’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Desmond K. Runyan
aKempe Center for the Prevention and Treatment of Child Abuse and Neglect, Denver, Colorado;
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Abstract

OBJECTIVE: Child physical abuse is commonly missed, putting abused children at risk for repeated injury and death. Several so-called sentinel injuries have been suggested to be associated with high rates of abuse, and to imply the need for routine testing for other, occult traumatic injuries. Our objective was to determine rates of abuse evaluation and diagnosis among children evaluated at leading children’s hospitals with these putative sentinel injuries.

METHODS: This is a retrospective secondary analysis of the Pediatric Health Information System database. We identified 30 355 children with putative sentinel injuries. We measured rates of abuse diagnosis and rates of testing commonly used to identify occult injuries.

RESULTS: Among all visits for children <24 months old to Pediatric Health Information System hospitals, the rate of abuse diagnosis was 0.17%. Rates of abuse diagnosis for children with at least 1 putative sentinel injury ranged from 3.5% for children <12 months old with burns to 56.1% for children <24 months with rib fractures. Rates of skeletal survey and other testing that can identify occult traumatic injury were highly variable between centers and for different injuries.

CONCLUSIONS: Several putative sentinel injuries are associated with high rates of physical abuse. Among eligible children with rib fracture(s), abdominal trauma, or intracranial hemorrhage, rates of abuse were more than 20%. Future work is warranted to test whether routine testing for abuse in these children can improve early recognition of abuse.

  • Accepted August 4, 2015.
  • Copyright © 2015 by the American Academy of Pediatrics
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Pediatrics
Vol. 147, Issue 1
1 Jan 2021
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Testing for Abuse in Children With Sentinel Injuries
Daniel M. Lindberg, Brenda Beaty, Elizabeth Juarez-Colunga, Joanne N. Wood, Desmond K. Runyan
Pediatrics Oct 2015, peds.2015-1487; DOI: 10.1542/peds.2015-1487

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Testing for Abuse in Children With Sentinel Injuries
Daniel M. Lindberg, Brenda Beaty, Elizabeth Juarez-Colunga, Joanne N. Wood, Desmond K. Runyan
Pediatrics Oct 2015, peds.2015-1487; DOI: 10.1542/peds.2015-1487
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