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Cited by 1,134Child Abuse and Related TraumaHomicide, Infanticide, and Child AbuseChild Abuse and Trauma

Analysis of missed cases of abusive head trauma

Jenny, Carole·1999·JAMA
DOI 10.1001/jama.281.7.621
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Abstract

CONTEXT: Abusive head trauma (AHT) is a dangerous form of child abuse that can be difficult to diagnose in young children. OBJECTIVES: To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis. DESIGN: Retrospective chart review of cases of head trauma presenting between January 1, 1990, and December 31, 1995. SETTING: Academic children's hospital. PATIENTS: One hundred seventy-three children younger than 3 years with head injuries caused by abuse. MAIN OUTCOME MEASURES: Characteristics of head-injured children in whom diagnosis of AHT was unrecognized and the consequences of the missed diagnoses. RESULTS: Fifty-four (31.2%) of 173 abused children with head injuries had been seen by physicians after AHT and the diagnosis was not recognized. The mean time to correct diagnosis among these children was 7 days (range, 0-189 days). Abusive head trauma was more likely to be unrecognized in very young white children from intact families and in children without respiratory compromise or seizures. In 7 of the children with unrecognized AHT, misinterpretation of radiological studies contributed to the delay in diagnosis. Fifteen children (27.8%) were reinjured after the missed diagnosis. Twenty-two (40.7%) experienced medical complications related to the missed diagnosis. Four of 5 deaths in the group with unrecognized AHT might have been prevented by earlier recognition of abuse. CONCLUSION: Although diagnosing head trauma can be difficult in the absence of a history, it is important to consider inflicted head trauma in infants and young children presenting with nonspecific clinical signs.

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  • Classification of injury based on GCS has limitations including inter-observer reliability, timing after injury, reduced meaning after repeated injury and assessment, and use of medications at the scene potentially altering scoring.

    “Classification of injury based on GCS has limitations including inter-observer reliability, timing after injury, reduced meaning after repeated injury and assessment, as well as use of medications at the scene of the accident potentially altering scoring [16,17,18].”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [18]

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Authors
Jenny, C.
Affiliations
Brown University (US)
Corresponding author
Jenny, Carole
ORCID
Jenny, Carole
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
1999-02-17
Volume
281
Issue
7
Pages
621
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.281.7.621
OpenAlex
W2137968618
Cited by
1,134
References
32
Citations by year
2026: 34 · 2025: 54 · 2024: 48 · 2023: 51 · 2022: 63 · 2021: 61 · 2020: 65 · 2019: 47 · 2018: 54 · 2017: 50 · 2016: 43 · 2015: 55 · 2014: 54 · 2013: 47 · 2012: 34
FWCI
17.93
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child Abuse and Related Trauma
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords
shaken baby syndrome, missed diagnosis, child abuse, delayed diagnosis, injury recurrence, medical complications, infant mortality, risk factors
MeSH terms
Child Abuse, Child, Preschool, Diagnostic Errors, Female, Craniocerebral Trauma, Humans, Infant, Infant, Newborn, Male, Retrospective Studies

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