Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse

Resmiye Oral; Fatih Yagmur; Marcus Nashelsky; Munevver Turkmen; Patricia Kirby

doi:10.1097/PEC.0b013e31818e9f5d

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Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse

Journal article

Peer reviewed

Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse

Resmiye Oral, Fatih Yagmur, Marcus Nashelsky, Munevver Turkmen and Patricia Kirby

Pediatric emergency care, Vol.24(12), pp.816-821

12/2008

DOI: 10.1097/PEC.0b013e31818e9f5d

PMID: 19050665

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Abstract

Missed diagnosis of child abuse may lead to chronic abuse with potential for death. This paper reports 3 such cases. This is a retrospective chart review of 38 cases diagnosed as abusive head trauma between January 1, 2004 and December 31, 2006 at a university hospital. We sought to identify fatal cases with a past medical history of physical abuse that was missed by the medical staff. Three cases (7.9%) had a past medical history of physical abuse that was missed by the medical staff. Infants were 2 males and 1 female. Their ages were 2.5, 3.5, and 6 months, respectively. Missed abuse episodes involved rib fractures, a metaphyseal tibial fracture, and a shaking episode, respectively. The intervals that had elapsed between the missed and the fatal abuse episodes were 24 hours, 12 days, and 6 weeks, respectively. Perpetrators of fatal head trauma were all biological fathers. One plead guilty, and 2 were convicted of involuntary manslaughter. The infants were in the care of the perpetrators of the fatal abuse episodes at the time the missed abuse episodes occurred. Physicians assessing children, especially infants, should be alert to indicators of abusive trauma to recognize abuse early on. Including abusive trauma in the differential diagnostic list and taking appropriate steps to rule out or confirm the diagnosis are of paramount importance in establishing child protective services and preventing further abuse and neglect that may at times be fatal.

Retinal Detachment - etiology

Retinal Hemorrhage - etiology

Humans

Tibial Fractures - diagnostic imaging

Patient Care Team

Infant

Male

Fractures, Bone - diagnosis

Shaken Baby Syndrome - diagnosis

Encephalocele - mortality

Fractures, Bone - etiology

Diagnostic Errors

Shaken Baby Syndrome - etiology

Battered Child Syndrome - diagnosis

Female

Retrospective Studies

Fractures, Bone - diagnostic imaging

Cerebral Hemorrhage - etiology

Tibial Fractures - diagnosis

Hospitals, University - statistics & numerical data

Deception

Status Epilepticus - etiology

Medical Records

Encephalocele - etiology

Radiography

Interdisciplinary Communication

Ribs - injuries

Homicide

Shaken Baby Syndrome - mortality

Fathers

Tibial Fractures - etiology

Details

Title: Subtitle: Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse
Creators: Resmiye Oral - Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. resmiye-oral@uiowa.edu
Fatih Yagmur
Marcus Nashelsky
Munevver Turkmen
Patricia Kirby
Resource Type: Journal article
Publication Details: Pediatric emergency care, Vol.24(12), pp.816-821
Publisher: United States
DOI: 10.1097/PEC.0b013e31818e9f5d
PMID: 19050665
ISSN: 0749-5161
eISSN: 1535-1815
Language: English
Date published: 12/2008
Academic Unit: Stead Family Department of Pediatrics; Epidemiology; Pathology
Record Identifier: 9984046804302771

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