R: Child Maltreatment Trauma and CPK Levels

["Oddone Virginio" <oddovir@xxxxxxxxx>]

CPK levels are a marker of muscular damage; they can be elevated in a
number of diseases and the type of damaged cells (whether muscle or heart)
may be identified by biochemical analysis (research of the isoenzymes)
which can be routinely performed by any hospital laboratory. The problem is
that it is not a very safe marker, because CPK may rise as a consequence of
any innocent trauma, even minimal (e.g. intramuscular injection). CPK is
NOT the only marker of muscular damage, although it is the first and the
fastest to grow; it rapidly decreases; other markers are LDH and GOP and
GPT. In my experience they are not a very faithful indicator of abuse.

It certainly arises as a consequence of serious trauma; I observed it in a
few cases, two of them as a consultant of the Prosecution (in Continental
Europe experts' judicial role is much wider than in common law countries) :
a child who had been savagely beaten with what we call "ox nerve" (I don't
know the english translation), we counted at least 44 hits, CPK arose about
tenfold its normal level; in another case, a shaken baby syndrome, there
were signs of muscular damage with the typical movements of first CPK, then
LDH and GOP and GPT. They were accepted by the courts, but their overall
usefulness was very limited: tell tale pictures were the
greatest proof in the first case, CT scans in the second.

You may find more information on CPK in any Internal Medicine Handbook
(e.g., in
any edition of Harrison's).

Virginio Oddone, MD
V. Avogadro 6
10121 - Torino
Italy

oddovir@ipsnet.it



----------
> Da: FrampD@aol.com
> A: Child Maltreatment Researchers  
<CHILD-MALTREATMENT-RESEARCH-L@cornell.edu>
> Oggetto: Child Maltreatment Trauma and CPK Levels
> Data: luned“ 5 ottobre 1998 17.08
> 
> I was recently involved in a trial of a protective services case where
the
> primary issue was the timing of various injuries to a child.  We had a
Doctor
> who is a trauma expert testify that, from his experience, levels of CPK
> (creatine phosphokinase) measured over time can be reliable to indicate
the
> age of injuries to the child's muscle structure.
> 
> Is anyone aware of any research on the use of CPK levels in the
investigation
> of child physical abuse?
> 
> Frampton Durban, Jr.
> Chief Legal Counsel
> Charleston County DSS
> 3366 Rivers Ave.
> North Charleston, S. C. 29405
> (843) 740-0625
> FAX (843) 740-0629