Re: Abdominal Trauma & Child Abuse - The Lancet

["Virginio Oddone" <oddovir@xxxxxxxxx>]

In the latest issue of the british medical journal "The Lancet" there is a
very interesting paper on "Abdominal Trauma due to Child Abuse" which, to my
knowledge, is the first real epidemiological study to-date on the subject.
In my personal experience, this is a frequently overlooked phenomenon (see
below for the abstract).

http://www.thelancet.com/journals/lancet/full?volume=366&issue=9481
http://www.thelancet.com/journals/lancet/article/PIIS0140673605669139/abstract

Virginio


Dr. Virginio ODDONE, M.D.
V. Avogadro 6
10121 - Torino (Italy)
e-mail: oddovir@ipsnet.it
 medico.legale@cto.to.it

******************
J'ai enfin le droit de saluer des êtres que je ne connais pas
Ils passent devant moi et s'accumulent au loin
Tandis que tout ce que j'en vois m'est inconnu
Et leur espoir n'est pas moins fort que le mien.
(Apollinaire, Le musicien de Saint-Merry.)

****************


The Lancet 2005; 366:234-235

DOI:10.1016/S0140-6736(05)66913-9

Abdominal injury due to child abuse
Peter M Barnes a,   Catherine M Norton a,   Frank D Dunstan b,   Alison M
Kemp a,   David W Yates c   and   Jonathan R Sibert

Summary
Diagnosis of abuse in children with internal abdominal injury is difficult
because of limited published work. We aimed to ascertain the incidence of
abdominal injury due to abuse in children age 0-14 years. 20 children
(identified via the British Paediatric Surveillance Unit) had abdominal
injuries due to abuse and 164 (identified via the Trauma Audit and Research
Network) had injuries to the abdomen due to accident (112 by road-traffic
accidents, 52 by falls). 16 abused children were younger than 5 years.
Incidence of abdominal injury due to abuse was 2·33 cases per million
children per year (95% CI 1·43-3·78) in children younger than 5 years. Six
abused children died. 11 abused children had an injury to the gut (ten small
bowel) compared with five (all age >5 years) who were injured by a fall
(relative risk 5·72 [95% CI 2·27-14·4]; p=0·0002). We have shown that
small-bowel injuries can arise accidentally as a result of falls and
road-traffic accidents but they are significantly more common in abused
children. Therefore, injuries to the small bowel in young children need
special consideration, particularly if a minor fall is the explanation.

Affiliations

a Department of Child Health, Cardiff University, Academic Centre, Llandough
Hospital, Penarth CF64 2XX, UK
b Department of Epidemiology, Statistics, and Public Health, Cardiff
University, Academic Centre, Llandough Hospital, Penarth CF64 2XX, UK
c Trauma Audit and Research Network, Hope Hospital, Salford M6 8HD, UK