Child Welfare

Emergency Department Screening for Occult Abdominal Trauma in Physically Abused Children

Official Title: Emergency Department Screening for Occult Abdominal Trauma in Physically Abused Children
Multi-Center Research Lead: Wendy Lane, MD, MPH
CHOP Site Lead: Joanne N. Wood, MD, MSHP
Johns Hopkins Children’s Hospital Site Lead: Mitchell Goldstein, MD, MBA
Children’s National Medical Center Site Lead: James Campbell, MD
Sponsored By: Eunice Kennedy Shriver National Institute on Child Health and Development
Dates: September 2008 – Ongoing

Background

Screening physically abused children for occult abdominal trauma (OAT) is recommended by child abuse experts.  Despite this recommendation, screening is not performed consistently in some emergency departments.  Furthermore, the prevalence of occult abdominal trauma among physically abused children is not known.

Aims

• To identify the prevalence of occult abdominal trauma in children with suspected physical abuse.
• To determine the factors associated with increased likelihood of occult abdominal trauma in children who have been physically abused.
• To determine the frequency of emergency department visits for overt abusive abdominal trauma.
• To determine the factors associated with being a victim of overt abusive abdominal trauma.

Methods

Study Design: Prospective cross-sectional study of children presenting to four pediatric emergency departments with an injury complaint suspected of physical abuse.

Population: Children aged 0-6 from 4 urban pediatric emergency departments.

Progress

Data collection is in progress.

Policy Focus

The project will inform evidence-based recommendations regarding which children with suspected physical abuse should be screened for occult abdominal trauma.

Relevant Resources

Coant PN, Kornberg AE, Brody AS, Edwards-Holmes K.  Markers for occult liver injury in cases of physical abuse in children. Pediatrics. 1992;89:274-278.

Jenny C; American Academy of Pediatrics, Committee on Child Abuse and Neglect.  Evaluating infants and young children with multiple fractures.  Pediatrics. 2006;118:1299-1303.

Kellogg ND. Evaluation of suspected child physical abuse. Pediatrics. 2007;119(6):1232-1241.

Lane W, Lotwin I, Dubowitz H, Langenberg P, Dischinger P.  Outcomes of children hospitalized for abusive abdominal trauma.  Pediatrics.  2011. 127:e1400-e1405. doi:10.1542/peds.2010-2096.

Lane WG, Dubowitz H, Langenberg P.  Screening for occult abdominal trauma among children with suspected physical abuse.  Pediatrics.  2009; 124:1595-1602.  doi:10.1542/peds.2009-0904.

Lindberg D, Makaroff K, Harper N, et al.  Utility of hepatic traminases to recognize abuse in children.  Pediatrics. 2009;124:509-516.

Wood J, Rubin DM, Nance M, Christian CW: Distinguishing inflicted versus accidental abdominal injuries in young children. J Trauma 2005; 59(5): 1203-1208.