Non-accidental Injury Research Articles

Utility and limitations of postmortem computed tomography in animal abuse suspected cases: A case series study of cats

ObjectivesInjuries caused by animal abuse are termed non-accidental injuries, and should be distinguished from accidental injuries. We compared postmortem computed tomography (PMCT) and necropsy findings in deceased cat bodies suspected of having been abused to determine whether findings previously reported to be associated with abuse or accident could be ascertained by necropsy or PMCT. Materials and methodsSeven deceased cat bodies requested by the police for necropsy because of suspicion of animal abuse were used to compare necropsy and PMCT findings. ResultsPMCT revealed gas distribution abnormalities, such as pneumocephalus and pneumothorax, and bone lesions findings, such as cervical and pelvic fracture; however, several of these were not confirmed at necropsy. Findings such as liver contusion and injury to the posterior vena cava were confirmed only by necropsy and not by PMCT. Findings related to animal abuse, i.e., ocular injuries, skull, bilateral rib, and femoral fractures were confirmed by both PMCT and necropsy in 3, 5, 2, and 2 cats, respectively. Pneumothorax, pelvic fracture, and sacroiliac luxation, related to accidents, were confirmed only by CT in 6 of 6, 1 of 4, and 2 of 2 bodies. ConclusionPMCT revealed gas- and some bone-related findings more efficiently than necropsy, and a combination of PMCT and necropsy is recommended to perform, particularly if the death circumstances is unknown.

“A child isn’t born bitter”: (In)human Relations and Monstrous Affects in Hiromi Goto’s The Kappa Child

This article presents an intersectional reading of Hiromi Goto’s The Kappa Child (2001) through the lens of Affect Theory. Particularly, I draw from Sara Ahmed’s The Promise of Happiness and Lauren Berlant’s Cruel Optimism to analyze the role these notions play in the novel. I focus on the economy of affects that circulates among the characters and the affective significance of their interactions as well as the novel’s engagement with Ahmed’s notion of the promise of happiness and Berlant’s cruel optimism, specifically in relation to female, racialized, and migrant subjects both at a personal level and in the context of the settler colonial nation. My main argument is that the affects and expectations presented in the novel are monstrous. I defend that the protagonist’s affective monstrosity is a direct consequence of her abusive childhood as a racialized migrant in the Canadian Prairies and that choosing to let go of her expectations leads to emotional healing and opens new possibilities towards happiness.

Understanding Black and Latino sexual minority men's perspectives on assessment of sexual history in diverse health care settings.

This exploratory analysis aims to understand conditions under which cisgender Black and Latino sexual minority men (SMM) would be willing to share potentially abusive childhood sexual experiences with health care providers. Black and Latino SMM may be overrepresented among childhood sexual abuse (CSA) survivors, but some abusive experiences are appraised as consensual due to cultural pressures, leading to underreporting and a delay in identification and treatment. Prior research highlights the importance of screening for sexual abuse histories in primary care and substance use treatment settings, though studies indicate that such assessments rarely occur. In-depth qualitative interviews were conducted with 61 cisgender Black and Latino SMM who reported sexual experiences in childhood that met criteria for CSA. Interviews explored men's experiences with and attitudes toward sexual history taking in diverse health care settings. Most respondents felt that providers should assess sexual history and be aware of prior abuse. Barriers to disclosure included perceived provider bias and insincerity and concerns that provider characteristics (e.g., gender) might limit their ability to understand a client's experiences. Findings suggest that a trauma-informed approach to the assessment of sexual histories should consider that patients' current physical and mental states may be (in)directly linked to earlier, traumatic events and that intersecting identities (e.g., gender and race) could influence men's willingness to share their histories. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reconsidering the best interests of the child construct

BackgroundIn many ways modern child protection systems begin with the 1962 seminal article ‘The battered-child syndrome’ by Kempe and colleagues. The article focused on injuries to a child presented at a hospital that were at variance with the explanation given by a parent regarding the occurrence of the trauma. What followed somewhat later from this seminal article was the introduction in 1974 in the US of mandatory reporting of child abuse and prevention legislation that defined what must be reported. This legislation was influenced by the equally seminal ‘In the best interest of the child’ construct as developed by Goldstein and colleagues that was published in book form in 1973. ObjectiveThe purpose of this commentary is to call attention to limitations to how the “best interests of the child” has been implemented. ConclusionThis article provides an overview of criticisms of the best interests construct and suggestions that the construct is a dated view about what is in a child’s best interests. There is a need for a new balance between explanations about child abuse and neglect (CAN) that takes account of poverty, social disadvantage, and the interests of children and their families.

Atraumatic Limping Child, a Challenge for Pediatricians: An Observational Age-Related Study in a Pediatric Emergency Department.

Atraumatic limping is a frequent cause of consultation in Pediatric Emergency Departments (PED) and often represents a challenge for pediatricians for its variability in etiology ranging from benign causes to potential crippling conditions. The aims of this research are to illustrate the clinical features of acute limping children (LC) and to identify the possible red flags that could help to make a diagnosis of severe pathologies. We carried out a retrospective study about non-traumatic limping children referred to the PED of Bambino Gesù Children's Hospital over a 2-year period. We divided the cohort into three groups based on the patient's age: toddlers, children and adolescents. We considered crippling conditions: oncologic etiologies, bone or neurological infections, epiphysiolysis, Perthes disease, Guillain Barrè syndrome and non-accidental injuries. We analyzed 485 patients. At clinical evaluation, 19.5% of the patients presented at least one sign and/or symptom of red flags. Crippling conditions (6.2% of the total population) showed red flags in 36.7%. Transient synovitis of the hip was the most frequent diagnosis. We found crippling conditions in 30 patients, mostly represented by toddlers. Our data suggest that toddlers and patients presenting red flags should be evaluated with particular suspicion because they have an increased risk of underlying severe conditions.

Hyperincarceration and human rights abuses of First Nations children in juvenile detention in Queensland and the Northern Territory

ABSTRACT Hyperincarceration of First Nations peoples (both children in juvenile detention and adults in prisons) is a feature common to British settler colonial states. This article focuses on hyperincarceration of one population sub-group in one settler colonial state: children in Australian juvenile detention facilities. The treatment of First Nations children in Australian juvenile detention violates a number of Treaty obligations to which Australia has voluntarily committed. The article will focus on the treatment in two Australian jurisdictions – the Northern Territory and Queensland – where there have been high-profile instances of mistreatment that have garnered international and national attention and criticism. The treatment in these jurisdictions demonstrates the inconsistency between the international human rights law requirements and current legislation and policy. It argues that mistreatment that violates human rights law is directly contributed to by the hyperincarceration of First Nations children in juvenile detention, which is on a worsening trajectory.

Which elements of hospital-based clinical decision support tools for the assessment and management of children with head injury can be adapted for use by paramedics in prehospital care? A systematic mapping review and narrative synthesis

ObjectiveHospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT scanning. However, there is no decision tool to...

“I read the rules and know what is expected of me”: The performance of competence and expertise in ‘newbie’ offenders’ membership requests to dark web child abuse communities

Community-building among groups of child abusers on the ‘dark web’ facilitates the large-scale distribution of indecent imagery and supports individuals in becoming more skilled, more dangerous offenders. Undercover police are tasked with posing as offenders to gather intelligence; however, we know little about the nature of these groups, and especially how one might approach them linguistically as an ‘authentically’ interested outsider. This study analyses rhetorical moves (Swales, 1990) in forum posts from child abuse-related dark web fora by self-identifying ‘newbies’ hoping to join established abuse communities. It identifies 12 distinct moves used in the pursuit to join online abuse communities and finds that expressions of competence and expertise are central to newbies’ attempts to gain community membership. ‘De-lurking’ is identified as a useful strategy in the performance of competence in online forums. These findings can support online undercover policing tasks as well as offender prioritisation.

P14 Midface Toddler Excoriation Syndrome (MiTES): a new mimic of non-accidental injury

Abstract Background Midface Toddler Excoriation Syndrome (MiTES) is a rare genetic condition first described in 2017. Commencing in the first year of life, it is characterised by intense mid-­facial itch with persistent scratching and skin breakdown. Symptoms improve later in childhood, leaving atrophic scarring. Disbelief that infants can damage themselves in this way can lead to an erroneous and damaging misdiagnosis of non-accidental injury (NAI). Cases A boy now aged 11 years presented at 6 months with recurrent scratching of the face, leading to ulceration of the nasal bridge, sides of the nose, infraorbital areas and central forehead. Extensive investigations were unhelpful and NAI was suspected with significant psychosocial sequelae for the family. When his sister, now aged 4 years, presented with strikingly similar lesions MiTES was suspected and confirmed by genetic testing which showed homozygosity for 18 alanine repeats in the PRDM12 gene. Testing of sibling and parents is planned. Both children are now asymptomatic but have significant facial scarring. Discussion Biallelic variants in PRDM12 usually cause hereditary sensory and motor neuropathy type 8 with widespread damage to distal appendages due to pain insensitivity. The specific variant found here and in all reported MiTES cases causes highly localised lesions with rarely any extra-facial ­involvement. Due to its novelty and rarity, MiTES may be misdiagnosed and safeguarding concerns raised, leading to distress for affected families and breakdown of parent-­provider relationships. This case, which for the first time provides longitudinal data on affected siblings, highlights the need for early recognition and diagnosis.

Non-Accidental Injury Involving a Neonate

Non-accidental injury (NAI) was brought forward by the investigation and research that was conducted by Ambroise Tardieu, John Caffey and Henry Kempe. Whiplash-shaken infant syndrome and battered child syndrome are the other alternative terms used. NAI is defined as repetitive physical abuse. Marks of injuries such as multiple bruises or abrasions of differing ages and patterns, bite marks, burns and radiological evidence of old bony fractures are valuable indicators in distinguishing nonaccidental from accidental injuries. In addition, birth trauma, bleeding disorders, sepsis, vasculopathy, congenital anomalies, metabolic abnormalities and true accidental injuries must be ruled out beforehand with a meticulous approach when dealing with such deaths. Here, we report a case of a 28-day-old female neonate who was brought in unresponsive by her parents and was pronounced dead at the accident and emergency department. The external examination did not reveal any gross abnormality whereas, the internal examination revealed subgaleal haematoma, subdural and subarachnoid haemorrhage. The microscopic examination revealed retinal haemorrhage. The cause of death was attributed to blunt force trauma to the head. This case is a reminder to all forensic and clinical pathologists that an extremely uncommon manifestation can occur, therefore, a meticulous approach should always be undertaken, before corroborating a cause of death. In conclusion, the findings of the forensic autopsy and histopathology facilitated the investigation and established the cause of death.

Growth and weight deficiency due to the battered child syndrome during the SARS-CoV-2 pandemic

Growth and weight deficiency due to the battered child syndrome during the SARS-CoV-2 pandemic

DELAYED DISCHARGE OF PATIENTS WITH SUSPECTED NON-ACCIDENTAL INJURY

Child abuse is an essential discussion within society and poses many challenges. The international literature describes patient and family based risk factors and suspicious injuries. We have created a protocol for the identification and investigation of children with suspected non-accidental injuries. The paediatric orthopaedic ward experiences many children being delayed in the ward once fit for discharge. This study aimed to quanitify those delayed discharges and describe the demographics and risk factors for abuse within the local population.After obtaining ethics clearance, we conducted a retrospective review of records from the Teddy Bear Clinic, as well as admission records. The study examined demographic characteristics, family, injury characteristics and referral to Child Welfare. The delay of discharge from hospital was quantified and was compared to those characteristics.Records were collected from 1 January 2015 to 31 December 2021. Seventy-nine complete records were included. There were 40 males and 39 females with an average age of 20 months. 75.9% were under 36 months old. 94.1% of the cases sustained lower limb fractures. Fifty-two cases had a delayed discharge. The delay ranged from 1 to 233 days. There was an association between an age less than 36 months and delayed discharge. There were no significant correlations between caregiver characteristics and delayed discharge. The later the completion of investigations, the more likely there would be a delay. There was also a significant correlation between referral to Child Welfare and delayed discharge.Children under 36 months on this remain at highest risk for non-accidental injury. Delayed discharge was associated with age less than 36 months, upper limb fractures and referral to Child Welfare.Despite the delayed discharge, most children returned to the same home environments

Resilience-Informed Community Violence Prevention and Community Organizing Strategies for Implementation: Protocol for a Hybrid Type 1 Implementation-Effectiveness Trial.

Community violence is a persistent and challenging public health problem. Community violence not only physically affects individuals, but also its effects reverberate to the well-being of families and entire communities. Being exposed to and experiencing violence are adverse community experiences that affect the well-being and health trajectories of both children and adults. In the United States, community violence has historically been addressed through a lens of law enforcement and policing; the impact of this approach on communities has been detrimental and often ignores the strengths and experiences of community members. As such, community-centered approaches to address violence are needed, yet the process to design, implement, and evaluate these approaches is complex. Alternatives to policing responses are increasingly being implemented. However, evidence and implementation guidance for community-level public health approaches remain limited. This study protocol seeks to address community violence through a resilience framework-Adverse Community Experiences and Resilience (ACE|R)-being implemented in a major US city and leveraging a strategy of community organizing to advance community violence prevention. The objective of this research is to understand the impact of community-level violence prevention interventions. Furthermore, we aim to describe the strategies of implementation and identify barriers to and facilitators of the approach. This study uses a hybrid type 1 effectiveness-implementation design. Part 1 of the study will assess the effectiveness of the ACE|R framework plus community organizing by measuring impacts on violence- and health-related outcomes. To do so, we plan to collect quantitative data on homicides, fatal and nonfatal shootings, hospital visits due to nonaccidental injuries, calls for service, and other violence-related data. In Part 2 of the study, to assess the implementation of ACE|R plus community organizing, we will collect process data on community engagement events, deliver community trainings on community leadership and organizing, and conduct focus groups with key partners about violence and violence prevention programs in Milwaukee. This project received funding on September 1, 2020. Prospective study data collection began in the fall of 2021 and will continue through the end of 2023. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2024. Community violence is a public health problem in need of community-centered solutions. Interventions that center community and leverage community organizing show promise in decreasing violence and increasing the well-being of community members. Methods to identify the impact of community-level interventions continue to evolve. Analysis of outcomes beyond violence-specific outcomes, including norms and community beliefs, may help better inform the short-term and proximal impacts of these community-driven approaches. Furthermore, hybrid implementation-effectiveness trials allow for the inevitable contextualization required to disseminate community interventions where communities drive the adaptations and decision-making. DERR1-10.2196/50444.

Epidemiology of Paediatric Trauma During National Lockdown: A Retrospective Study With 12 Months of Follow-Up.

Introduction The COVID-19 pandemic and its associated preventative measures such as national lockdown dramatically changed the daily activities of children. This paper aims to compare the epidemiology of paediatric orthopaedic trauma presentation, management and outcomes during the school closure period with the matched pre-pandemic period in 2019. Methods This was a retrospective cohort study of data collected from the West Yorkshire Trauma Network, comprising a major trauma centre, Leeds General Infirmary, and five peripheral trauma units. All patients aged 0-18 years who required trauma unit management during the school closure period (18 March 2020-25 May 2020) were included. Cases for the matched period in 2019 were analysed for baseline comparison. Patient demographics, mechanism and anatomical location of injury, management and follow-up were assessed. Results In the 2020 and 2019 cohorts, 286 and 575 injuries were observed, respectively. In the 2020 cohort, we observed a 50.3% (n=289) fall in paediatric trauma presentation and a significant proportional reduction in referrals from the emergency department (22% (n=63) versus 53% (n=305); p<0.001).There was also a significant reduction in the average age at presentation by more than one year (p<0.001). Sports-related injuries decreased significantly (n=16 (5.6%) versus n=127 (22.1%); p<0.001). While the proportion of ride-on injuries increased significantly, overall numbers remained similar (n=63 (22%) versus n=61 (10.6%); p<0.0001). Non-accidental injury (NAI) concerns rose significantly (n=9 (3.1%) versus n=4 (0.7%); p=0.01), but the absolute number of confirmed NAI cases stayed the same (n=2). There was a proportional increase in upper limb injuries (64.3% (n=184) versus 58.4% (n=336); p>0.05) and a proportional reduction in lower limb injuries (32.1% (n=92) versus 35.5% (n=204); p>0.05). However, the rate of tibial shaft injuries rose significantly (10.1% (n=29) versus 5.2% (n=30); p=0.02). The use of conservative management increased with a significant delay in average time to surgery from the date of injury (8.5 days versus 3.1 days; p=0.01). Patients who were only followed up with a telephone consultation rose significantly (23% (n= 66) versus 6% (n=35); p<0.001). Re-presentation rate increased significantly (1.4% (n=4) versus 0.2% (n=12); p=0.04). Conclusion Our study showed a reduction in paediatric trauma presentations during the pandemicand a significant reduction in the average age at presentation. This change has been accompanied by a shift in the mechanism and anatomical location of injury, management and subsequent follow-up.

Mental illness in children and its determinants in Ethiopia: A systematic review and meta-analysis, 2023.

Young people are at risk of developing mental health disorders. Depression, anxiety, and behavioral problems are among the primary causes of illness and impairment among teenagers. Suicide is the fourth highest cause of mortality in those aged 15 to 29. This study aimed to assess the determinants of mental health among children in Ethiopia. Online databases were searched from inception until March 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 was used in this review. Subgroup analysis, I2 test, funnel plot, and Egger's test were performed. Pooled odds ratios (OR) were calculated. Fourteen studies were included in the meta-analysis. The pooled prevalence of mental illnesses among Ethiopian children was 24.68% (95% CI: 19.99%-32.38%). Having previous child abuse history (OR: 5.65; 95% CI: 4.32-7.39), poor socio-economic status (OR: 1.94; 95% CI: 1.24-3.04), urban residence (OR: 1.93; 95% CI:1.39-2.67), and being male (OR: 1.65; 95% CI: 1.15-2.38) were determinants of childhood mental illness in Ethiopia. and Recommendations: Mental disorders are highly prevalent in children with a history of child abuse, and a strong legislative body must be established to prosecute child abusers. Interventions that focus on gender equality in education and the creation of a safe environment for poor urban children are suggested.

Paediatric thoracic actinomycosis presenting as back swelling: A case report

Presentation: A seven years old girl presented with a three-day history of cough and fever, and several weeks of back pain, anorexia and weight loss. Examination was significant only for a tender, non-erythematous swelling to the right mid-back measuring ten centimetres in length. Diagnosis and treatment: Investigations on admission included neutrophilia and elevated inflammatory markers. Chest radiograph demonstrated a confluent area of opacification within the right peripheral lower zone with a small pleural effusion. CT reported two large enhancing and infiltrative lesions in the right thorax and the right posterior lower ribs, and disseminated lymphadenopathy. Microbiology and histology of a tissue sample were conclusive for actinomycosis israelii. She had a full recovery following a nine month course of oral amoxicillin. Discussion: Invasive actinomycosis is rare, and a high clinical suspicion and thorough investigation is warranted with invasive pneumonia and atypical associated symptoms. Keywords: Actinomycosis; Pneumonia; Chest wall mass; non-accidental injury.

Non-accidental injuries in children

Non-accidental injuries in children

Review of standard paediatric neuroradiology MRI protocols from 12 UK tertiary paediatric hospitals: is there much variation between centres?

To investigate how magnetic resonance imaging (MRI) examinations are protocolled in tertiary paediatric neuroradiology centres around the UK for some of the more common presentations encountered in paediatric neuroradiology, and to identify any variations of note. All 19 UK tertiary paediatric neuroradiology centres registered with the British Society of Neuroradiologists-Paediatric Group were contacted and asked if they could provide a copy of their standard MRI protocols. Twelve responded (63%) and 10 of the more common presentations were selected and the standard acquired sequences obtained at each participating centre were compared. Where available the collated protocols were also compared against current published guidance. The basic sequences carried out by centres around the UK are similar; however, there are lots of variations overall. The only standardised protocol currently being implemented nationally in paediatric imaging is that for brain tumours. Otherwise, chosen protocols are generally dependent on the preferences and technical capabilities of individual centres. Suggested published protocols also exist for non-accidental injury (NAI), multiple sclerosis, epilepsy, and head and neck imaging. The differences in MRI protocolling depend in part on technical capabilities and in part on the experience and preferences of the paediatric neuroradiologists at each centre. For most presentations, there is no consensus as to what constitutes the perfect protocol. The present results will be useful for specialist centres who may wish to review their current protocols, and for more generalist centres to use as a reference to guide their MRI protocolling.

Terapeuters tanker om gjenopprettende prosess når barn begår seksuelle overgrep: en kvalitativ studie

Background: Restorative process has been used as a treatment intervention in cases where children sexually abuse other children. However, empirical knowledge of the method is scarce. Aim: This study aims to explore therapists` reflections on how restorative process affects children who participate. Method: We conducted semi-structured interviews with 12 therapists working with sexually abused children and child abusers. Six of the participants had experience in using restorative process. Data were analyzed using thematic analysis. Results: The analysis resulted in three themes: (1) becoming stronger, (2) making matters worse, and (3) restorative conditions. Conclusion: The majority of the therapists point out that restorative process can be helpful if it is well prepared, both children want to participate, and the abuser takes responsibility. Without these factors, restorative process can be harmful, especially for the victim. Keywords: harmful sexual behaviour, child sexual abuse, restorative process, qualitative method, therapist experience

P14 Blueberry muffin syndrome secondary to acute myeloid leukaemia: a learning point

Abstract A baby was initially referred at 6 weeks developing multiple erythematous, bruise-like and light-brown subdermal lumps over the head, face, arms, legs and buttocks. She had been born following breech presentation by elective C-section, which had been complicated by trauma and blood loss. No other clinical concerns were raised at this time. Nonaccidental injury was considered; however, subcutaneous fat necrosis of the newborn was the diagnosis made by paediatric team following slightly raised calcium and suggestive ultrasounds features. Newer lesions continued to arise in the same areas over 6 weeks, now with difficulty in feeding and irritability. One small cervical lymph node could be palpated. This was atypical for subcutaneous fat necrosis of the newborn and an urgent dermatological option was sought. On review, the lesions were clinically in keeping with an infiltrative process (blueberry muffin syndrome) and an urgent skin biopsy, blood film and TORCH screen were requested. A 4-mm punch biopsy confirmed leukaemia cutis with evidence of myeloid differentiation. MLL (KMT2A) rearrangement was detected, which was also subsequently found on a bone marrow sample. A peripheral blood film identified a population for NG2-positive myeloid blasts (6%), raising the possibility of infant acute myeloid leukaemia (AML). A TORCH screen did not highlight any congenital infections. The baby was promptly commenced on chemotherapy for AML. This case highlights how presentation can be atypical, the importance of reviewing possible diagnoses and considering an early biopsy to enable prompt treatment if required.