| Analysis of missed cases of abusive head trauma. | |
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MedLine Citation:
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PMID: 10029123 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: Abusive head trauma (AHT) is a dangerous form of child abuse that can be difficult to diagnose in young children. OBJECTIVES: To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis. DESIGN: Retrospective chart review of cases of head trauma presenting between January 1, 1990, and December 31, 1995. SETTING: Academic children's hospital. PATIENTS: One hundred seventy-three children younger than 3 years with head injuries caused by abuse. MAIN OUTCOME MEASURES: Characteristics of head-injured children in whom diagnosis of AHT was unrecognized and the consequences of the missed diagnoses. RESULTS: Fifty-four (31.2%) of 173 abused children with head injuries had been seen by physicians after AHT and the diagnosis was not recognized. The mean time to correct diagnosis among these children was 7 days (range, 0-189 days). Abusive head trauma was more likely to be unrecognized in very young white children from intact families and in children without respiratory compromise or seizures. In 7 of the children with unrecognized AHT, misinterpretation of radiological studies contributed to the delay in diagnosis. Fifteen children (27.8%) were reinjured after the missed diagnosis. Twenty-two (40.7%) experienced medical complications related to the missed diagnosis. Four of 5 deaths in the group with unrecognized AHT might have been prevented by earlier recognition of abuse. CONCLUSION: Although diagnosing head trauma can be difficult in the absence of a history, it is important to consider inflicted head trauma in infants and young children presenting with nonspecific clinical signs. |
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Authors:
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C Jenny; K P Hymel; A Ritzen; S E Reinert; T C Hay |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 281 ISSN: 0098-7484 ISO Abbreviation: JAMA Publication Date: 1999 Feb |
Date Detail:
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Created Date: 1999-03-03 Completed Date: 1999-03-03 Revised Date: 2006-11-07 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 621-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA. cjenny@lifespan.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Child Abuse
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diagnosis*,
statistics & numerical data Child, Preschool Craniocerebral Trauma / epidemiology, etiology* Diagnostic Errors Female Humans Infant Infant, Newborn Male Retrospective Studies |
| Comments/Corrections | |
Comment In:
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JAMA. 1999 Oct 20;282(15):1421; author reply 1422
[PMID:
10535426
]
JAMA. 1999 Oct 20;282(15):1421-2 [PMID: 10535427 ] JAMA. 1999 Oct 20;282(15):1421; author reply 1422 [PMID: 10535425 ] JAMA. 1999 Feb 17;281(7):657-9 [PMID: 10029130 ] |
Erratum In:
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JAMA 1999 Jul 7;282(1):29 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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