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Child Abuse

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Analysis of missed cases of abusive head trauma.
Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC.
JAMA. 1999 Feb 17;281(7):621-6.

Rationale for inclusion: The diagnosis of child abuse can be challenging and the consequences of missing the diagnosis can be lethal.  This study evaluates children with a missed diagnosis of abusive head trauma.  In these children, it took seven days to arrive at the correct diagnosis. Over 1/4 of these children were re-injured during that time, and 40% had medical complications related to the missed diagnosis.  Of the five children who died, four of these deaths were preventable if child abuse had been recognized sooner. This paper serves as a clarion call to the healthcare community to have a low threshold for evaluation of potential child abuse, given the potentially devastating consequences of missing this diagnosis. 

Citations - 747 (as of July 2017)

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS.
Am J Prev Med. 1998 May;14(4):245-58.

Rationale for inclusion: This study evaluated exposure to adverse events in childhood and the relationship to adult health.  It identified a graded "dose response" relationship between adverse events in childhood (physical abuse, sexual abuse, emotional abuse) and causes of death in adulthood (ischemic heart disease, cancer, lung disease, liver disease, etc.). This study highlights the potentially widespread, lifetime benefits to prevention and treatment of child abuse. 

Citations - 5948 (as of July 2017)

Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial.
Olds DL, Eckenrode J, Henderson CR Jr, Kitzman H, Powers J, Cole R, Sidora K, Morris P, Pettitt LM, Luckey D.
JAMA. 1997 Aug 27;278(8):637-43.

Rationale for inclusion: Long term follow up to a prospective randomized trial to prevent child abuse demonstrates beneficial effects to families fifteen years later.  The intervention of home visits by a nurse prenatally and through the first two years correlated with decreased child abuse and neglect, decreased number of subsequent pregnancies, decreased use of welfare, decreased substance abuse, and decreased criminal behavior.

Citations - 1637 (as of July 2017)

Preventing child abuse and neglect: a randomized trial of nurse home visitation.
Olds DL, Henderson CR Jr, Chamberlin R, Tatelbaum R.
Pediatrics. 1986 Jul;78(1):65-78.

Rationale for inclusion: A rare prospective randomized trial in child abuse examined the intervention of home visitation by a nurse during the prenatal and infant time periods.  During these two years, children in the intervention group had fewer instances of abuse and neglect, fewer ED visits, and fewer accidents and poisonings.  This study demonstrates that effective prevention of child abuse is possible and has meaningful benefits. 

Citations - 1140 (as of July 2017)

The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation.
Caffey J.
Pediatrics. 1974 Oct;54(4):396-403.

Rationale for inclusion: The injury mechanism of common infant non-accidental trauma is first described in this paper.  It identifies shaking rather than blunt battering as the cause of subdural hematoma, ocular hemorrhage, and brain injury. It clarifies how severely injured infants may not have significant external findings of trauma. This paper was important in dispelling the notion of a "spontaneous" subdural hematoma in infants. 

Citations - 748 (as of July 2017)

The battered-child syndrome.
Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK.
JAMA. 1962 Jul 7;181:17-24.

Rationale for inclusion: Kempe's paper is the first to describe the medical manifestations of non-accidental trauma.  The authors coined the phrase "battered child syndrome" to characterize the constellation of findings including childhood fractures, subdural hematoma, soft tissue swelling, skin bruising, failure to thrive, and sudden death. They highlight the importance of injury that does not correlate to the described history. This early paper remains compelling and foresightedly contemporary.

Citations - 4004 (as of July 2017)

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