Retinal hemorrhage variation in inertial versus contact head injuries.

Background: Abusive head trauma (AHT) is frequently accompanied by dense/extensive retinal hemorrhages to the periphery with or without retinoschisis (complex retinal hemorrhages, cRH). cRH are uncommon without AHT or major trauma.

Objective: The study objectives were to determine whether cRH are associated with inertial vs.

Iatrogenic Flexion-Related Classic Metaphyseal Lesion of the Distal Tibia: Three Cases.

Background: Classic metaphyseal lesions (CMLs) should raise concern for nonaccidental trauma. However, iatrogenic causes for CMLs have increasingly been described and warrant close consideration. Increasing the clinical understanding of CML mechanics and their relation to often routine medical procedures will enhance provider awareness and expand the differential diagnosis when these otherwise highly concerning injuries are identified.

Skeletal survey yields in low vs. high risk pediatric patients with skull fractures.

Background: To assess for occult fractures, physicians often opt to obtain skeletal surveys (SS) in young, acutely head-injured patients who present with skull fractures. Data informing optimal decision management are lacking.

Objective: To determine the positive yields of radiologic SS in young patients with skull fractures presumed to be at low vs.

The association of subcortical brain injury and abusive head trauma.

Background: Abusive head trauma (AHT) remains a major pediatric problem with diagnostic challenges. A small pilot study previously associated subcortical brain injury with AHT.

Objectives: To investigate the association of subcortical injury on neuroimaging with the diagnosis of AHT.

Evaluation for Bleeding Disorders in Suspected Child Abuse.

Bruising or bleeding in a child can raise the concern for child abuse. Assessing whether the findings are the result of trauma and/or whether the child has a bleeding disorder is critical. Many bleeding disorders are rare, and not every child with bruising/bleeding that may raise a concern for abuse requires an evaluation for bleeding disorders.

An analysis of physicians' diagnostic reasoning regarding pediatric abusive head trauma.

Background: Physician diagnoses of abusive head trauma (AHT) have been criticized for circular reasoning and over-reliance on a "triad" of findings. Absent a gold standard, analyses that apply restrictive reference standards for AHT and non-AHT could serve to confirm or refute these criticisms.

Objectives: To compare clinical presentations and injuries in patients with witnessed/admitted AHT vs.

Screening for pediatric abusive head trauma: Are three variables enough?

Background: The PediBIRN 4-variable clinical decision rule (CDR) detects abusive head trauma (AHT) with 96% sensitivity in pediatric intensive care (PICU) settings. Preliminary analysis of its performance in Pediatric Emergency Department settings found that elimination of its fourth predictor variable enhanced screening accuracy.

Objective: To compare the AHT screening performances of the "PediBIRN-4" CDR vs.

A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings.

Objective: To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings.

Study Design: This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures <3 years (n = 183 and n = 237, intervention vs control).

Abusive Head Trauma and a Delay in Presentation for Care.

Objectives: Abusive head trauma (AHT) is the leading cause of death from trauma in children less than 2 years of age. A delay in presentation for care has been reported as a risk factor for abuse; however, there has been limited research on this topic. We compare children diagnosed with AHT to children diagnosed with accidental head trauma to determine if there is a delay in presentation.

Estimating the Relevance of Historical Red Flags in the Diagnosis of Abusive Head Trauma.

Objective: To replicate the previously published finding that the absence of a history of trauma in a child with obvious traumatic head injuries demonstrates high specificity and high positive predictive value (PPV) for abusive head trauma.

Study Design: This was a secondary analysis of a deidentified, cross-sectional dataset containing prospective data on 346 young children with acute head injury hospitalized for intensive care across 18 sites between 2010 and 2013, to estimate the diagnostic relevance of a caregiver's specific denial of any trauma, changing history of accidental trauma, or history of accidental trauma inconsistent with the child's gross motor skills. Cases were categorized as definite or not definite abusive head trauma based solely on patients' clinical and radiologic findings.

Estimating the probability of abusive head trauma after abuse evaluation.

Background: Evidence-based, patient-specific estimates of abusive head trauma probability can inform physicians' decisions to evaluate, confirm, exclude, and/or report suspected child abuse.

Objective: To derive a clinical prediction rule for pediatric abusive head trauma that incorporates the (positive or negative) predictive contributions of patients' completed skeletal surveys and retinal exams.

Participants And Setting: 500 acutely head-injured children under three years of age hospitalized for intensive care at one of 18 sites between 2010 and 2013.

Clinical comparison of ocular and systemic findings in diagnosed cases of abusive and non-abusive head trauma.

Purpose: Child abuse is a leading cause of death in infants, which is often associated with abusive head trauma (AHT). The purpose of this retrospective analysis was to identify ocular and systemic findings in confirmed cases of AHT and compare them to a group of non-abusive head trauma (NAHT) patients.

Patients And Methods: A retrospective chart review of 165 patients with accidental and non-accidental trauma admitted between 2013 and 2015 to Children's Hospital and Medical Center in Omaha, NE, USA, was performed.

MR detection of retinal hemorrhages: correlation with graded ophthalmologic exam.

Background: Dilated fundoscopic exam is considered the gold standard for detecting retinal hemorrhage, but expertise in obtaining this exam is not always immediately available. MRI can detect retinal hemorrhages, but correlation of the grade or severity of retinal hemorrhage on dilated fundoscopic exam with retinal hemorrhage visibility on MRI has not been described.

Objective: To determine the value of standard brain protocol MRI in detecting retinal hemorrhage and to determine whether there is any correlation with MR detection of retinal hemorrhage and the dilated fundoscopic exam grade of hemorrhage.

Characteristics of falls and risk of injury in children younger than 2 years.

Introduction: Although many studies have shown that short falls by children rarely result in serious injury, no recent study in the United States has assessed the prevalence and the characteristics of such falls. Because the history of a short fall often is given in the instance of suspected child abuse, data addressing the characteristics, the frequency, and the severity of such falls would assist in abuse investigations.

Methods: Anonymous questionnaires were distributed at primary care offices to parents of children younger than 5 years.

Transverse fracture of the distal femoral metadiaphysis: a plausible accidental mechanism.

Objectives: This study describes the mechanism of injury of an impacted transverse fracture of the distal femoral metadiaphysis. Individual experience by child abuse pediatricians with this fracture type has suggested that it is less associated with inflicted trauma than was described in a prior case series.

Methods: Case contributions were solicited from an international group of child abuse clinicians.