Home accident or physical abuse: Evaluation of younger children presenting with trauma, burn and poisoning in the Pediatric Emergency Department

Özet

Most cases of physical abuse and neglect refer to pediatric emergency clinics,and these patients are diagnosed as only home accidents. Cases that cannotbe diagnosed and managed correctly are again exposed to severe trauma andconsequently, they may die. The aim of this study is to evaluate the physicalabuse and neglect in children younger than three years of age, admitted tothe pediatric emergency department with the complaints of trauma, burn, drugpoisoning and/or caustic ingestion. This prospective study included 132 patientswho were admitted to the pediatric emergency department. Children wereclassified into three groups as “no abuse”, “suspected abuse” and “abused”after being evaluated with a standard form. Additionally, suspected abuseand abused cases were evaluated once again by “The Team of Child Abuseand Neglect Evaluation, Research and Treatment” in Hacettepe University,İhsan Doğramacı Children's Hospital.The frequency of the suspected abuse or abused cases in all burn, trauma andpoisoning cases was found to be 7.5%. It was noticed that 65 of the patients(49.2%) were physically neglected considering the mechanism of occurrence ofevents. Unplanned pregnancy, absence of prenatal follow-up, high number ofsiblings, previous physical abuse in the family, absence of witness during theevent, and hospitalization were statistically significant differences between noabuse and suspected abuse or abused cases (p<0.05). Moreover, age groupand income were significant risk factors in the logistic regression model forthe patients who were thought to be suspected abuse/abused in univariateanalyses (age group: Odds ratio (OR) 0.279, 95% confidence interval (CI)0.085-0.723, p=0.0049; income: OR 2.323, 95% CI 1.052-6.198, p=0.0345).In conclusion, most cases of physical abuse and neglect are referred to thepediatric emergency clinics, and these patients are misdiagnosed as homeaccidents. The physicians working in the emergency department should beinformed and trained in recognizing the cases of abuse and neglect, makingthe differential diagnosis, identifying the high-risk families and appropriatephysical and psychological treatment for the abused and neglected children.