Suspected Physical Abuse Flashcards

1
Q

Who is the guidance set out by?

A

RCR and ScOR
RCPCH - the royal college of paediatrics and child health

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2
Q

What are the red flags to suspect physical abuse?

A

•No history
• inappropriate, inconsistent or implausible history
• conflicting
• Delay in presentation
• multiple injuries, different ages/ stages of healing, locations

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3
Q

3 common Types of injuries

A

Fractures - 2nd most common findings
Inter cranial injures - major cause of morbidity and mortality
Visceral injures - present later in time

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4
Q

What exams are required?

A

Skeletal survey <2years

skeletal survey plus ct head < 1

Children > 1 year with external evidence of head trauma or neurology -CT head

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5
Q

What is needed for a Skeletal survey?

A

Acquired and reported within 24 hours and no later than 72 hours

Performed 9-5 Monday to Friday

2trained paediatric radiographers to perform

Paediatric Rn or HCA must be present to assist with Immobilisation

Sedation can be used

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6
Q

What age is skeletal survey done?

A

Up to 2 years

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7
Q

Why do a follow up CXR?

A

To better visualise rib fractures

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8
Q

Neurological Imaging

A

Un- Enhanced CT with multi-planar reformats

MR head and spine day 2-6 if CT abnormal

CT should be considered in >1 if there are other injuries with high suspicion of abuse

Rib, spinal #, visceral trauma or retinal trauma

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9
Q

What is the protocol for a Deceased Child?

A

Postmortem imaging of whole body indicated in cases of SIDs

SS and CT head also completed

Whole body CT/MR if diagnosis in doubt

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10
Q

Which are the Low suspicion fracture areas?

A

-sub-periosteal new bone formation (SPNBF)
- Clavicle
- Shaft long-bone
- linear skull

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11
Q

Which are Moderate suspicion fracture locations?

A

+ multiple (especially bilateral)
+ different ages of healing fractures
+ Epiphyseal separations
+ vertebral bodies and subluxations
+ Digital fractures
+ complex skull fractures

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12
Q

Which are High suspicion fracture locations ?

A

~ Classical metaphysical lesions (CML)
~ rib fractures
~ scapular
~ spinous process
~ sternum

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13
Q

Mechanism of injuries vs injuries observed

A

Shaking, griping, twisting, pulling- metaphyseal injury
Gripping - sub Periosteal new bone formation
Direct blows or applied lever force - transverse fracture
Twisting - spiral fractures
Pulling - fracture separation

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14
Q

What injury does Shacking, twisting, gripping, pulling show?

A

Metaphyseal injury

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15
Q

What injury does Gripping show?

A

Subperiosteal new bone formation (SPNBF)

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16
Q

What injury does a Direct blow or applied lever force show?

A

Transverse fractures

17
Q

What injury does Twisting show?

A

Spiral fracture

18
Q

What injury does Pulling show?

A

Fracture separation