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Pediatric Radiology
Published in: Pediatric Radiology 6/2021

01-05-2021 | Abusive Head Injury | Child abuse imaging

Brief resolved unexplained events vs. child maltreatment: a review of clinical overlap and evaluation

Authors: Barbara H. Chaiyachati, Joanne N. Wood

Published in: Pediatric Radiology | Issue 6/2021

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Abstract

Within their first year, a number of infants present for medical evaluation because of unexplained changes in color, tone, breathing, or level of responsiveness. This broad collection of symptoms has an accordingly large differential diagnosis that includes both brief resolved unexplained event (BRUE) and child maltreatment. The overlap between clinical presentation for BRUE and maltreatment can present a diagnostic challenge — especially given the significant consequences for infants and families for diagnostic error at that juncture. In this review, we provide overviews of the presenting features and findings in cases of BRUE and child maltreatment with a focus on areas of overlap and differentiation.
Literature
1.
Semmekrot BA, van Sleuwen BE, Engelberts AC et al (2010) Surveillance study of apparent life-threatening events (ALTE) in the Netherlands. Eur J Pediatr 169:229–236CrossRef
2.
Kiechl-Kohlendorfer U, Hof D, Peglow UP et al (2005) Epidemiology of apparent life threatening events. Arch Dis Child 90:297–300CrossRef
3.
4.
Tieder JS, Bonkowsky JL, Etzel RA et al (2016) Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants: executive summary. Pediatrics 137:e20160590CrossRef
5.
[No authors listed] (1987) National Institutes of Health consensus development conference on infantile apnea and home monitoring, Sept 29 to Oct 1, 1986. Pediatrics 79:292–299
6.
Tieder JS, Altman RL, Bonkowsky JL et al (2013) Management of apparent life-threatening events in infants: a systematic review. J Pediatr 163:94–99CrossRef
7.
Davies F, Gupta R (2002) Apparent life threatening events in infants presenting to an emergency department. Emerg Med J 19:11–16CrossRef
8.
Brand DA, Altman RL, Purtill K, Edwards KS (2005) Yield of diagnostic testing in infants who have had an apparent life-threatening event. Pediatrics 115:885–893CrossRef
9.
Ueda R, Nomura O, Maekawa T et al (2017) Independent risk factors for recurrence of apparent life-threatening events in infants. Eur J Pediatr 176:443–448CrossRef
10.
Brand DA, Fazzari MJ (2018) Risk of death in infants who have experienced a brief resolved unexplained event: a meta-analysis. J Pediatr 197:63–67CrossRef
11.
Putnam-Hornstein E, Needell B, King B, Johnson-Motoyama M (2013) Racial and ethnic disparities: a population-based examination of risk factors for involvement with child protective services. Child Abuse Negl 37:33–46CrossRef
12.
Conrad-Hiebner A, Byram E (2020) The temporal impact of economic insecurity on child maltreatment: a systematic review. Trauma Violence Abuse 21:157–178CrossRef
13.
Kim H, Drake B (2018) Child maltreatment risk as a function of poverty and race/ethnicity in the USA. Int J Epidemiol 47:780–787CrossRef
14.
Parrish JW, Young MB, Perham-Hester KA, Gessner BD (2011) Identifying risk factors for child maltreatment in Alaska: a population-based approach. Am J Prev Med 40:666–673CrossRef
15.
Sidebotham P, Heron J, ALSPAC Study Team (2006) Child maltreatment in the "children of the nineties": a cohort study of risk factors. Child Abuse Negl 30:497–522CrossRef
16.
Altman RL, Brand DA, Forman S et al (2003) Abusive head injury as a cause of apparent life-threatening events in infancy. Arch Pediatr Adolesc Med 157:1011–1015CrossRef
17.
Bonkowsky JL, Guenther E, Filloux FM, Srivastava R (2008) Death, child abuse, and adverse neurological outcome of infants after an apparent life-threatening event. Pediatrics 122:125–131CrossRef
18.
Guenther E, Powers A, Srivastava R, Bonkowsky JL (2010) Abusive head trauma in children presenting with an apparent life-threatening event. J Pediatr 157:821–825CrossRef
19.
Parker K, Pitetti R (2011) Mortality and child abuse in children presenting with apparent life-threatening events. Pediatr Emerg Care 27:591–595CrossRef
20.
Jenny C, Hymel KP, Ritzen A et al (1999) Analysis of missed cases of abusive head trauma. JAMA 281:621–626CrossRef
21.
Pierce MC, Kaczor K, Thompson R (2014) Bringing back the social history. Pediatr Clin N Am 61:889–905CrossRef
22.
Pierce MC, Kaczor K, Aldridge S et al (2010) Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics 125:67–74CrossRef
23.
Pierce MC, Kaczor K, Lorenz DJ et al (2017) Bruising clinical decision rule (BCDR) discriminates physical child abuse from accidental trauma in young children. Pediatric Academic Societies, San Francisco
24.
Sugar NF, Taylor JA, Feldman KW (1999) Bruises in infants and toddlers: those who don't cruise rarely bruise. Puget Sound Pediatric Research Network. Arch Pediatr Adolesc Med 153:399–403
25.
Altman RL, Forman S, Brand DA (2007) Ophthalmologic findings in infants after an apparent life-threatening event. Eur J Ophthalmol 17:648–653CrossRef
26.
Curcoy AI, Trenchs V, Morales M et al (2010) Retinal hemorrhages and apparent life-threatening events. Pediatr Emerg Care 26:118–120CrossRef
27.
Pitetti RD, Maffei F, Chang K et al (2002) Prevalence of retinal hemorrhages and child abuse in children who present with an apparent life-threatening event. Pediatrics 110:557–562CrossRef
28.
Christian CW, Levin AV, Council on Child Abuse and Neglect et al (2018) The eye examination in the evaluation of child abuse. Pediatrics 142:e20181411
29.
Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics (2015) The evaluation of suspected child physical abuse. Pediatrics 135:e1337–e1354CrossRef
30.
Section on Radiology, American Academy of Pediatrics (2009) Diagnostic imaging of child abuse. Pediatrics 123:1430–1435CrossRef
31.
32.
Duffy SO, Squires J, Fromkin JB, Berger RP (2011) Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics 127:e47–e52CrossRef
33.
Rubin DM, Christian CW, Bilaniuk LT et al (2003) Occult head injury in high-risk abused children. Pediatrics 111:1382–1386CrossRef
34.
Trout AT, Strouse PJ, Mohr BA et al (2011) Abdominal and pelvic CT in cases of suspected abuse: can clinical and laboratory findings guide its use? Pediatr Radiol 41:92–98CrossRef
35.
Lindberg D, Makoroff K, Harper N et al (2009) Utility of hepatic transaminases to recognize abuse in children. Pediatrics 124:509–516CrossRef
Metadata
Title
Brief resolved unexplained events vs. child maltreatment: a review of clinical overlap and evaluation
Authors
Barbara H. Chaiyachati
Joanne N. Wood
Publication date
01-05-2021
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 6/2021
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-020-04793-z

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