Sentinel injuries in infants evaluated for child physical abuse. Pediatrics 2013 Apr;131(4):701-7
Date
03/13/2013Pubmed ID
23478861DOI
10.1542/peds.2012-2780Scopus ID
2-s2.0-84875986416 (requires institutional sign-in at Scopus site) 262 CitationsAbstract
OBJECTIVE: Relatively minor abusive injuries can precede severe physical abuse in infants. Our objective was to determine how often abused infants have a previous history of "sentinel" injuries, compared with infants who were not abused.
METHODS: Case-control, retrospective study of 401, <12-month-old infants evaluated for abuse in a hospital-based setting and found to have definite, intermediate concern for, or no abuse after evaluation by the hospital-based Child Protection Team. A sentinel injury was defined as a previous injury reported in the medical history that was suspicious for abuse because the infant could not cruise, or the explanation was implausible.
RESULTS: Of the 200 definitely abused infants, 27.5% had a previous sentinel injury compared with 8% of the 100 infants with intermediate concern for abuse (odds ratio: 4.4, 95% confidence interval: 2.0-9.6; P < .001). None of the 101 nonabused infants (controls) had a previous sentinel injury (P < .001). The type of sentinel injury in the definitely abused cohort was bruising (80%), intraoral injury (11%), and other injury (7%). Sentinel injuries occurred in early infancy: 66% at <3 months of age and 95% at or before the age of 7 months. Medical providers were reportedly aware of the sentinel injury in 41.9% of cases.
CONCLUSIONS: Previous sentinel injuries are common in infants with severe physical abuse and rare in infants evaluated for abuse and found to not be abused. Detection of sentinel injuries with appropriate interventions could prevent many cases of abuse.
Author List
Sheets LK, Leach ME, Koszewski IJ, Lessmeier AM, Nugent M, Simpson PAuthors
Lynn Sheets MD Professor in the Pediatrics department at Medical College of WisconsinPippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Case-Control StudiesChild Abuse
Contusions
Female
Humans
Infant
Male
Mouth
Retrospective Studies
Wounds and Injuries