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High Frequency of Previous Abuse and Missed Diagnoses Prior to Abusive Head Trauma: A Consecutive Case Series of 100 Forensic Examinations.

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Title: High Frequency of Previous Abuse and Missed Diagnoses Prior to Abusive Head Trauma: A Consecutive Case Series of 100 Forensic Examinations.
Authors: Laurent‐Vannier, Anne, Bernard, Jonathan Y., Chevignard, Mathilde
Source: Child Abuse Review. May/Jun2020, Vol. 29 Issue 3, p231-241. 11p. 3 Charts.
Subjects: Prevention of child abuse, Cephalometry, Child abuse, Children's accident prevention, Diagnostic errors, Case studies, Skull fractures, Spinal injuries, Subdural hematoma, Vomiting, Bruises, Head injuries, Retrospective studies, Early diagnosis, Data analysis software, Descriptive statistics, Adverse childhood experiences
Geographic Terms: France
Abstract: This study describes the frequency of signs and symptoms of abuse and missed diagnoses prior to the diagnosis of abusive head trauma (AHT) in infants. Data were from a retrospective observational study of 100 consecutive cases of infants diagnosed with AHT over a seven‐year period. The most frequent symptom leading to the diagnosis was a loss of consciousness (68%) that always occurred inside a home (parents' or nanny's), never outside. Diagnosis was established using criteria based on the child's lesions and the alleged history. Lesions leading to diagnosis were described: 99 per cent had multifocal subdural haematoma (SDH) located in four areas including lateral space, interhemispheric, tentorium cerebelli and vertex; 60 per cent had a rupture of bridging veins. Previous abuse was found in 79 per cent of cases, of whom 75 per cent underwent medical consultations that did not result in a diagnosis of abuse. The main signs and symptoms of previous abuse were repeated vomiting without fever or diarrhoea (62%), abnormal head circumference increase (49%) and bruises (38%). These results suggest a higher frequency of repeated abuse than previous studies and highlight the great challenges most professionals encounter to evoke and set the diagnosis of abuse. 'This study describes the frequency of signs and symptoms of abuse and missed diagnoses prior to the diagnosis of abusive head trauma (AHT) in infants' Key Practitioner Messages: Prior signs and symptoms suggestive of abuse are particularly frequent in infants diagnosed with AHT.Abuse must be detected as early as possible in order to avoid recurrences.Diagnostic criteria, based on clinical history and lesions including multifocal subdural haematoma, rupture of bridging veins, retinal haemorrhages, and spinal cord injury have been defined to enable diagnosis of AHT. [ABSTRACT FROM AUTHOR]
Copyright of Child Abuse Review is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: High Frequency of Previous Abuse and Missed Diagnoses Prior to Abusive Head Trauma: A Consecutive Case Series of 100 Forensic Examinations.
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  Data: This study describes the frequency of signs and symptoms of abuse and missed diagnoses prior to the diagnosis of abusive head trauma (AHT) in infants. Data were from a retrospective observational study of 100 consecutive cases of infants diagnosed with AHT over a seven‐year period. The most frequent symptom leading to the diagnosis was a loss of consciousness (68%) that always occurred inside a home (parents' or nanny's), never outside. Diagnosis was established using criteria based on the child's lesions and the alleged history. Lesions leading to diagnosis were described: 99 per cent had multifocal subdural haematoma (SDH) located in four areas including lateral space, interhemispheric, tentorium cerebelli and vertex; 60 per cent had a rupture of bridging veins. Previous abuse was found in 79 per cent of cases, of whom 75 per cent underwent medical consultations that did not result in a diagnosis of abuse. The main signs and symptoms of previous abuse were repeated vomiting without fever or diarrhoea (62%), abnormal head circumference increase (49%) and bruises (38%). These results suggest a higher frequency of repeated abuse than previous studies and highlight the great challenges most professionals encounter to evoke and set the diagnosis of abuse. 'This study describes the frequency of signs and symptoms of abuse and missed diagnoses prior to the diagnosis of abusive head trauma (AHT) in infants' Key Practitioner Messages: Prior signs and symptoms suggestive of abuse are particularly frequent in infants diagnosed with AHT.Abuse must be detected as early as possible in order to avoid recurrences.Diagnostic criteria, based on clinical history and lesions including multifocal subdural haematoma, rupture of bridging veins, retinal haemorrhages, and spinal cord injury have been defined to enable diagnosis of AHT. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Child Abuse Review is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1002/car.2638
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        Text: English
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        PageCount: 11
        StartPage: 231
    Subjects:
      – SubjectFull: Prevention of child abuse
        Type: general
      – SubjectFull: Cephalometry
        Type: general
      – SubjectFull: Child abuse
        Type: general
      – SubjectFull: Children's accident prevention
        Type: general
      – SubjectFull: Diagnostic errors
        Type: general
      – SubjectFull: Case studies
        Type: general
      – SubjectFull: Skull fractures
        Type: general
      – SubjectFull: Spinal injuries
        Type: general
      – SubjectFull: Subdural hematoma
        Type: general
      – SubjectFull: Vomiting
        Type: general
      – SubjectFull: Bruises
        Type: general
      – SubjectFull: Head injuries
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Early diagnosis
        Type: general
      – SubjectFull: Data analysis software
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      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Adverse childhood experiences
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      – SubjectFull: France
        Type: general
    Titles:
      – TitleFull: High Frequency of Previous Abuse and Missed Diagnoses Prior to Abusive Head Trauma: A Consecutive Case Series of 100 Forensic Examinations.
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            NameFull: Laurent‐Vannier, Anne
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            NameFull: Bernard, Jonathan Y.
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              M: 05
              Text: May/Jun2020
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              Y: 2020
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