TABLE 7.

Description of Discrepant Cases of Not Definite Abuse

Historical FeaturesClinical SummaryDisposition
Not Definite Abuse Cases Reported to State Child Protective Services
1-mo-old fell 3.5 feet from a tableSubarachnoid and subdural hemorrhages, no retinal hemorrhages, no fractures on skeletal survey, no skin findings.Home with family
6-mo-old presented to primary care physician with scalp swelling and no initial history of trauma. Later history offered: fall from bench and/or caregiver dropped infant on head. Mom initially refused skeletal survey. History of corporal punishment.Parietal skull fracture and small associated subdural hemorrhage. No retinal hemorrhages, no fractures on skeletal survey, no skin findings other than scalp swelling.Home with family, family refused recommended psychiatric evaluation
5-mo-old fell 2 feet from bedSubdural hemorrhage on head CT. No retinal hemorrhages, no fractures on skeletal survey, no skin findings.Home with family
11-mo-old tipped over in a walker by sibling (walker did not fall down stairs)Patient arrived to emergency department with lethargy, bradycardia, and decreased right-sided movement.Placed in foster care with relative
Epidural hematoma on head CT and liver contusion on abdominal CT. No retinal hemorrhages, no fractures on skeletal survey, no skin findings.
10-mo-old fell 1 foot in bathtub in the care of babysitter. Two previous visits for minor head trauma.Subdural hemorrhage on head CT. No retinal hemorrhages, no fractures on skeletal survey, no skin findings.Home with family; unclear if legal action taken against babysitter
7-mo-old fell 2.5 feet from bed and 4 h later was hard to arouse. Similar fall at 3 mo of age.Patient was lethargic upon arrival. Head CT showed epidural hemorrhage and old subdural hemorrhage. No retinal hemorrhages, no fractures on skeletal survey, no skin findings.Home with family
4-mo-old fell with mother when she slipped on ice while carrying childNormal neurologic exam on arrival. Small epidural hemorrhage and question of old subdural hemorrhage on head CT. No retinal hemorrhages, no fractures on skeletal survey, no skin findings.Home with family
Cases of Not Definite Abuse Presenting With “No History of Trauma”
10 mo-old with increasing head circumference noted by primary care provider. No history of trauma.Head CT showed bilateral subacute subdural hematomas. No fractures on skeletal survey, no skin findings. Ophthalmologic exam not done. Social work assesment done, but no child protection team involvement.Home with family
7-mo-old presented with vomiting and lethargy. No initial history of trauma.Patient arrived with lethargy and bradycardia. Head CT showed an epidural hematoma. No fractures on skeletal survey, no skin findings, no retinal hemorrhages. Hospital child protection team involved. Not reported to state.Home with family
After head CT results discussed with family, dad said that she may have had a recent fall out of bed. It was later offered that a sibling may have inflicted trauma.
2-mo-old presented with seizure and no history of trauma. After head CT results discussed with family, mother offered that a 4-y-old sibling probably hit infant with a toy out of jealousy.Patient was postictal upon arrival. Head CT showed 2 subdural hemorrhages. There were no retinal hemorrhages, no fractures on skeletal survey, and no skin findings. Not reported to the state.Home with family; in subsequent follow-up visits, mother continued to suggest that other relatives (aunt, cousins) could be responsible for undisclosed trauma
  • CT indicates computed tomography.