![]() ![]() Ībusive head trauma (AHT) is the most fatal form of non-accidental injury in children. These patterns have low to moderate specificity for NAT. Other described non-accidental patterns to consider include epiphyseal separations, vertebral body fractures and separations, digital fractures, linear and complex skull fractures, and subperiosteal bone formation. Therefore, these fractures (especially if coupled with clavicular fractures) are more specific for NAT in younger patients, and the specificity decreases with advancing age. Of note, spiral fractures of long bones generally result from twisting injuries (indicating NAT), but can occur accidentally from falls in ambulatory children. Multiple fractures, especially if in different stages of healing Ĭlavicular fractures and spiral fractures of long bones in nonambulatory children Similarly, there is no consensus regarding socioeconomic status as it relates to NAT risk, but studies have shown that incidence of non-accidental head trauma and its severity rise during times of economic recession. There is no consensus regarding whether a particular race is at greatest risk for NAT however black children have a greater risk of mortality from NAT. Many other suspected risk factors have been studied. Personal history of being abused as a childĮxposure to foster care or abandonment as a childĮngagement in criminal activity or corporal punishment as a child Increased number of separations from the child in the first year Reported mechanism of injury is unexpected for the child’s developmental status (for instance, a 2 week old infant rolling off of a bed)Īge under 5 account for 81.5% of cases children under 1 are most vulnerable įemale parent (although males are more likely to inflict fatal NAT) Injuries inconsistent with the caregiver’s history Additionally, over 70% of reported NAT deaths in 2014 were in children under 3 years old. ![]() A recent study found that 97% of NAT cases have antecedent familial dysfunction, such as substance abuse (alcohol or drugs), psychiatric disorder, history of violence or incarceration, or child withdrawal. Children at greatest risk are generally toddler and younger, and often come from dysfunctional family units. NAT is a frequently missed diagnosis, but there are some red flags and risk factors that should make the EP take pause and consider this diagnosis. Therefore, the Emergency Physician (EP) must maintain a high index of suspicion for NAT to prevent the grave consequences of missed diagnosis for the patient and any other children in the home. Furthermore, the diagnosis of NAT is delayed in 20% of cases, increasing the risk of poor outcomes. Compared with accidental pediatric trauma, patients with NAT have been shown to have higher injury severity scores, rates of intensive care unit admission, and mortality. ![]() The classic signs and symptoms of NAT will be reviewed here, but it is important to realize that occult injury is common. NAT is most commonly encountered in young children, but can occur at any age. In 2014 alone, there were 1546 reported deaths from NAT and 3.6 million child abuse referrals submitted to Child Protective Services (CPS). Non-accidental trauma (NAT) is a leading cause of pediatric traumatic injury and death. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |