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Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse.
[child syndrome]
Missed
diagnosis
of
child
abuse
may
lead
to
chronic
abuse
with
potential
for
death
.
This
paper
reports
3
such
cases
.
This
is
a
retrospective
chart
review
of
38
cases
diagnosed
as
abusive
head
trauma
between
January
1
,
2004
and
December
31
,
2006
at
a
university
hospital
.
We
sought
to
identify
fatal
cases
with
a
past
medical
history
of
physical
abuse
that
was
missed
by
the
medical
staff
.
Three
cases
(
7
.
9
%
)
had
a
past
medical
history
of
physical
abuse
that
was
missed
by
the
medical
staff
.
Infants
were
2
males
and
1
female
.
Their
ages
were
2
.
5
,
3
.
5
,
and
6
months
,
respectively
.
Missed
abuse
episodes
involved
rib
fractures
,
a
metaphyseal
tibial
fracture
,
and
a
shaking
episode
,
respectively
.
The
intervals
that
had
elapsed
between
the
missed
and
the
fatal
abuse
episodes
were
24
hours
,
12
days
,
and
6
weeks
,
respectively
.
Perpetrators
of
fatal
head
trauma
were
all
biological
fathers
.
One
plead
guilty
,
and
2
were
convicted
of
involuntary
manslaughter
.
The
infants
were
in
the
care
of
the
perpetrators
of
the
fatal
abuse
episodes
at
the
time
the
missed
abuse
episodes
occurred
.
Physicians
assessing
children
,
especially
infants
,
should
be
alert
to
indicators
of
abusive
trauma
to
recognize
abuse
early
on
.
Including
abusive
trauma
in
the
differential
diagnostic
list
and
taking
appropriate
steps
to
rule
out
or
confirm
the
diagnosis
are
of
paramount
importance
in
establishing
child
protective
services
and
preventing
further
abuse
and
neglect
that
may
at
times
be
fatal
.
Diseases
Validation
Diseases presenting
"episodes at the time"
symptom
child syndrome
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