Citation

Pierce MC, Kaczor K, Acker D, Webb T, Brenzel A, Lorenz DJ, Young A, Thompson R. Child Abuse Negl. 2017; 69: 263-277.

Affiliation

Richard H. Calica Center for Innovation in Children and Family Services, Juvenile Protective Association, 1707 N Halsted St., Chicago, IL 60614 USA.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.chiabu.2017.04.033

PMID

28500923

Abstract

Failure to recognize child maltreatment results in chronic exposure to high-risk environments where re-injury or death may occur. We analyzed a series (n=20) of fatal (n=10) and near-fatal (n=10) physical child abuse cases from the Commonwealth of Kentucky to identify commonalities and determine whether indicators of maltreatment were present prior to the child's fatal or near-fatal event. We conducted retrospective state record reviews involving children <4years of age classified as physical child abuse by the Cabinet for Health and Family Services during a 12 month period. Cases were distributed across 17 counties. IRB approvals were obtained. Three reviewers concurrently abstracted case data from medical, social, and legal documents, and descriptive statistics were analyzed. Median age of subjects was 7.5 months (range 1-32 months); 55% were male. Psychosocial risk factors (PRFs) were present in 100% of cases. Traumatic brain injury (95%) and bruising (90%) were the most common injuries. Of the 14 children with available prior medical records, 9 (64%) had sentinel injuries in the form of prior unexplained bruising; all nine suffered subsequent traumatic brain injury resulting in four deaths. A male was caring for the child at the time of the final event in 70% of cases. Our study identified key commonalities across cases of fatal and near-fatal abuse, highlighting the prevalence of psychosocial risk factors and the significance of prior unexplained bruising as a herald of escalating abuse. Further study is warranted to ascertain the predictive value of our findings in the larger population.

Copyright © 2017 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Child maltreatment; Homicide; Missed abuse; Recidivism; Sentinel injury