Paeds Cases · child-safety-and-social-paediatrics
Suspected inflicted abdominal injury — long case
Long case on a pre-verbal child with delayed presentation of a rigid abdomen: pattern recognition, occult-injury screening, concurrent trauma-and-safeguarding management and safe disposition.
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Study tools
Target exams
RACP DCEMRCPCH Clinical
Prompt
16-month-old with two days of vomiting and a rigid abdomen attributed to a 'tummy bug'; a short fall is offered as mechanism and there is a flank bruise.
Objectives
- Recognise that a delayed rigid abdomen with an under-explanatory mechanism is inflicted injury until proven otherwise. [1]
- Construct the laboratory occult-injury screen and imaging strategy for a stable child. [2] [6]
- Run trauma-team care and safeguarding concurrently, not sequentially. [1] [5]
- Secure safe disposition before discharge. [1]
References6ShowHide
- [1]Maguire SA A systematic review of abusive visceral injuries in childhood--their range and recognition Child Abuse Negl, 2013.PMID 23306146
- [2]Lindberg DM Utility of hepatic transaminases in children with concern for abuse Pediatrics, 2013.PMID 23319537
- [3]Sowrey L Duodenal injuries in the very young: child abuse? J Trauma Acute Care Surg, 2013.PMID 23271088
- [4]Kemp AM Patterns of skeletal fractures in child abuse: systematic review BMJ, 2008.PMID 18832412
- [5]Rosenfeld EH Understanding non-accidental trauma in the United States: A national trauma databank study J Pediatr Surg, 2020.PMID 31103270
- [6]Wootton-Gorges SL ACR Appropriateness Criteria(®) Suspected Physical Abuse-Child J Am Coll Radiol, 2017.PMID 28473090