{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T11:28:08Z","timestamp":1766748488307,"version":"3.40.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>The objective of this study is to determine which of the child abuse clues quoted in the literature predict nonaccidental trauma (NAT): history incongruent with injuries found on examination or imaging, old injuries present, history of trauma denied by caregivers, multiple fractures present, changing history, fractures of varied duration, metaphyseal fracture, ear bruise, neck bruise, different history (second historian), and metaphyseal fracture.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This is a 4-year retrospective study of all suspected NAT cases referred to our medical center. In addition to the index visit, medical records were searched for visits before the index visit with patient historical or physical findings that might have suggested NAT but were not investigated. The association of diagnostic clues and the outcome were assessed by chi-square and logistic regression analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>For 48 months, there were 109 cases of suspected NAT referred for evaluation (age range, 1 week to 15 years). After formal investigation by an abuse specialist, 79.3% of the cases were considered \u201clikely abuse\u201d. Those historical or physical findings with a univariate association with a final conclusion of likely abuse included history incongruent with injuries, old injuries present, trauma history denied, changed history, and retinal hemorrhage. In multivariate logistic regression, only a history incongruent with injures remained an independent predictor of likely abuse (odds ratio, 8.65; 95% confidence interval, 1.74\u201343.07; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.0151). After review of prior records, in only 2 of 109 cases (1.8%) was there a prior visit where NAT could have been suspected; however, history was thought to be congruent with the injury at the original visits.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In this 4-year study of NAT, the clinical clue that best predicted likely abuse after expert investigation was a history that was incongruent with the injuries found on emergency department evaluation. The incidence of possible early recognition from a prior emergency department visit in this group was very low, &lt;2% of cases.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003012","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T18:01:37Z","timestamp":1689703297000},"page":"641-645","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Nonaccidental Pediatric Trauma: Which Traditional Clues Predict Abuse?"],"prefix":"10.1097","volume":"39","author":[{"given":"Shad Masters","family":"Baab","sequence":"first","affiliation":[{"name":"Wake Forest School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James Fuller","family":"Lawsing","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cassandra Sarmiento","family":"Macalino","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob Hartry","family":"Springer","sequence":"additional","affiliation":[{"name":"Naval Medical Center Portsmouth, Portsmouth, VA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Martin","family":"Cline","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.pcl.2014.06.007","article-title":"Sentinel injuries: subtle findings of physical abuse","volume":"61","year":"2014","journal-title":"Pediatr Clin North Am"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1542\/peds.2012-2780","article-title":"Sentinel injuries in infants evaluated for child physical abuse","volume":"131","year":"2013","journal-title":"Pediatrics"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"e010788","DOI":"10.1136\/bmjopen-2015-010788","article-title":"Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study","volume":"6","year":"2016","journal-title":"BMJ Open"},{"key":"bib5-20250504","first-page":"e1337","article-title":"The evaluation of suspected child physical abuse","volume":"135","year":"2015","journal-title":"Pediatrics"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jpeds.2019.11.010","article-title":"Estimating the relevance of historical red flags in the diagnosis of abusive head trauma","volume":"218","year":"2020","journal-title":"J Pediatr"},{"key":"bib7-20250504","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1001\/archpedi.153.4.399","article-title":"Bruises in infants and toddlers: those who don't cruise rarely bruise. 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