Single Bruise Characteristics Associated With Abusive vs Accidental Injury.

Objectives: The TEN-4-FACESp bruising clinical decision rule (BCDR) is a validated screening tool utilizing information about a child's body region bruised, age, and pattern of bruising to predict abuse in children younger than 4 years of age. Our objectives were to (1) evaluate the accuracy of the BCDR in predicting abuse when only 1 bruise was present and (2) identify other characteristics differentiating abusive from accidental injury in young children with a single bruise.

Methods: Patients included in this secondary analysis were those from the BCDR validation study whose only skin finding was a single bruise (including petechiae, subconjunctival hemorrhage, or frenulum injury).

Epigenetic differences in stress response gene FKBP5 among children with abusive vs accidental injuries.

Background: Survivors of child abuse experience high rates of adverse physical and mental health outcomes. Epigenetic alterations in the stress response system, the FKBP5 gene specifically, have been implicated as one mechanism that may link abuse to lifelong health issues. Prior studies primarily included older individuals with a remote history of maltreatment; our objective was to test for differential methylation of FKBP5 in children with abusive vs accidental injuries at the time of diagnosis.

External Validation of the PediBIRN Screening Tool for Abusive Head Trauma in Pediatric Emergency Department Settings.

Methods: We conducted a retrospective, secondary analysis of an existing, deidentified, prospective data set captured to derive a bruising CDR. Subjects were patients under 3 years with bruising and confirmed acute head trauma. An expert medical panel had previously identified patients with AHT.

Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics.

Importance: Bruising caused by physical abuse is the most common antecedent injury to be overlooked or misdiagnosed as nonabusive before an abuse-related fatality or near-fatality in a young child. Bruising occurs from both nonabuse and abuse, but differences identified by a clinical decision rule may allow improved and earlier recognition of the abused child.

Objective: To refine and validate a previously derived bruising clinical decision rule (BCDR), the TEN-4 (bruising to torso, ear, or neck or any bruising on an infant <4.

Who's Watching the Children? Caregiver Features Associated with Physical Child Abuse versus Accidental Injury.

Objective: To compare caregiver features and caregiving arrangements of children with physical abuse vs accidental injuries.

Study Design: Data came from a prospective, observational, multicenter study investigating bruising and psychosocial characteristics of children younger than 4 years of age. Using logistic regression, we examined how abuse vs accidental injury and severity of injury were associated with caregiver sex, relation to the child, whether caregiving arrangements were different than usual at the time of injury, and length of the main caregiver's relationship with his/her partner.

Are negative/unrealistic parent descriptors of infant attributes associated with physical abuse?

Parents' perceptions of child behavior influence their responses to the child and may be important predictors of physical abuse. We examined whether infants 12 months of age or younger who were described with negative or developmentally unrealistic words were more likely than other infants to have been physically abused. As part of a prospective observational multicenter study investigating bruising and familial psychosocial characteristics, parents were asked to (1) describe their child's personality, and (2) list three words to describe their child.

Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach.

Objective: To assess interrater reliability and accuracy of an expert panel in classifying injuries of patients as abusive or accidental based on comprehensive case information.

Study Design: Data came from a prospective, observational, multicenter study investigating bruising characteristics of children younger than 4 years. We enrolled 2166 patients with broad ranges of illnesses and injuries presenting to one of 5 pediatric emergency departments in whom bruises were identified during examination.

Dataset on psychosocial risk factors in cases of fatal and near-fatal physical child abuse.

This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article "History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse" (Pierce et al., 2017) [1].

History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse.

Failure to recognize child maltreatment results in chronic exposure to high-risk environments where re-injury or death may occur. We analyzed a series (n=20) of fatal (n=10) and near-fatal (n=10) physical child abuse cases from the Commonwealth of Kentucky to identify commonalities and determine whether indicators of maltreatment were present prior to the child's fatal or near-fatal event. We conducted retrospective state record reviews involving children <4years of age classified as physical child abuse by the Cabinet for Health and Family Services during a 12 month period.

Is the Use of Physical Discipline Associated with Aggressive Behaviors in Young Children?

Objective: To determine the association between use of physical discipline and parental report of physically aggressive child behaviors in a cohort of young children who were without indicators of current or past physical abuse.

Methods: The data for this study were analyzed from an initial cohort of patients enrolled in a prospective, observational, multicenter pediatric emergency department-based study investigating bruising and familial psychosocial characteristics of children younger than 4 years of age. Over a 7-month period, structured parental interviews were conducted regarding disciplinary practices, reported child behaviors, and familial psychosocial risk factors.

The Prevalence of Bruising Among Infants in Pediatric Emergency Departments.

Study Objective: Bruising can indicate abuse for infants. Bruise prevalence among infants in the pediatric emergency department (ED) setting is unknown. Our objective is to determine prevalence of bruising, associated chief complaints, and frequency of abuse evaluations in previously healthy infants presenting to pediatric EDs.

Biomechanical investigation of the classic metaphyseal lesion using an immature porcine model.

Objective: The classic metaphyseal lesion is highly associated with abuse in infants. Classic metaphyseal lesions, also referred to as corner or bucket-handle fractures, are fractures through the metaphyseal region of the long bones near the growth plate. Knowledge of the biomechanics and mechanisms necessary to produce a classic metaphyseal lesion may provide insight into the injury causation associated with this unique fracture type.

Bringing back the social history.

The social environment of a child is a key determinant of the child's current and future health. Factors in a child's family environment, both protective and harmful, have a profound impact on a child's long-term health, brain development, and mortality. The social history may be the best all-around tool available for promoting a child's future health and well-being.

Bruising in infants: those with a bruise may be abused.

Bruising in the young infant is rare, and if present, this may be a manifestation of physical child abuse. Early signs of abuse, such as bruising, are often overlooked or their significance goes unrecognized resulting in poor patient outcomes. In such cases, the opportunity to intervene and potentially prevent repeat injury is lost, and the child is placed back in harm's way.

Bruising characteristics discriminating physical child abuse from accidental trauma.

Objective: Our objective was to conduct a pilot study to identify discriminating bruising characteristics and to model those findings into a decision tool for screening children at high risk for abuse.

Methods: A case-control study of children 0 to 48 months of age who were admitted to a PICU because of trauma was performed. Case subjects (N = 42) were victims of physical abuse, and control subjects (N = 53) were children admitted because of accidental trauma during the same time period.

Measurement of sodium ion concentration in undiluted urine with cation-selective polymeric membrane electrodes after the removal of interfering compounds.

The measurement of sodium ion concentration in urine can provide diagnostic information and guide therapy. Unfortunately, neutral-carrier-based ion-selective electrodes show a large positive drift and loss in selectivity in undiluted urine. The extraction of electrically neutral lipids from the urine into the sensing membrane was suggested as the main source of the drift, loss of selectivity and the consequent incorrect concentration readings.