{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T19:09:56Z","timestamp":1785006596414,"version":"3.55.0"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,12,1]]},"abstract":"<jats:p>OBJECTIVES: The goals were (1) to determine the prevalence of occult abdominal trauma (OAT) in a sample of children with suspected physical abuse, (2) to assess the frequency of OAT screening, and (3) to assess factors associated with screening.<\/jats:p><jats:p>METHODS: Charts of children evaluated for abusive injury were identified through a search of hospital discharge codes. Identified charts were reviewed to determine whether OAT screening occurred. Data on results of screening tests, abusive injuries identified, family demographic features, and characteristics of the emergency department visit were collected.<\/jats:p><jats:p>RESULTS: Screening occurred for 51 (20%) of 244 eligible children. Positive results were identified for 41% of those screened and 9% of the total sample; 5% of children 12 to 23 months of age had OAT identified through imaging studies. Screening occurred more often in children presenting with probable abusive head trauma (odds ratio [OR]: 20.4 [95% confidence interval [CI]: 3.6\u2013114.6]; P &amp;lt; .01), compared with those presenting with other injuries. Consultation with the child protection team (OR: 8.5 [95% CI: 3.5\u201320.7]; P &amp;lt; .01) and other subspecialists (OR: 24.3 [95% CI: 7.1\u201383.3]; P &amp;lt; .01) also increased the likelihood that OAT screening would occur.<\/jats:p><jats:p>CONCLUSIONS: Our findings support OAT screening with liver and pancreatic enzyme measurements for physically abused children. This study also supports the importance of subspecialty input, especially that of a child protection team. Although many identified injuries may not require treatment, their role in confirming or demonstrating increased severity of maltreatment may be critical.<\/jats:p>","DOI":"10.1542\/peds.2009-0904","type":"journal-article","created":{"date-parts":[[2009,11,24]],"date-time":"2009-11-24T02:44:08Z","timestamp":1259030648000},"page":"1595-1602","source":"Crossref","is-referenced-by-count":70,"title":["Screening for Occult Abdominal Trauma in Children With Suspected Physical Abuse"],"prefix":"10.1542","volume":"124","author":[{"given":"Wendy Gwirtzman","family":"Lane","sequence":"first","affiliation":[{"name":"Departments of Epidemiology and Preventive Medicine"},{"name":"Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Dubowitz","sequence":"additional","affiliation":[{"name":"Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Langenberg","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Preventive Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,12,1]]},"reference":[{"key":"2021120905220525000_R1","doi-asserted-by":"crossref","unstructured":"Schnitzer PG, Ewigman BG. Child deaths resulting from inflicted injuries: household risk factors and perpetrator characteristics. Pediatrics.\u20082005;116(5). Available at: www.pediatrics.org\/cgi\/content\/full\/116\/5\/e687","DOI":"10.1542\/peds.2005-0296"},{"key":"2021120905220525000_R2","doi-asserted-by":"crossref","unstructured":"Wood J, Rubin DM, Nance ML, Christian CW. Distinguishing inflicted versus accidental abdominal injuries in young children. J Trauma.\u20082005;59(5):1203\u20131208","DOI":"10.1097\/01.ta.0000196437.07011.b1"},{"key":"2021120905220525000_R3","doi-asserted-by":"crossref","unstructured":"Coant PN, Kornberg AE, Brody AS, Edwards-Holmes K. Markers for occult liver injury in cases of physical abuse in children. Pediatrics.\u20081992;89(2):274\u2013278","DOI":"10.1542\/peds.89.2.274"},{"key":"2021120905220525000_R4","unstructured":"Ludwig S. Visceral manifestations of child abuse. In: Reece RM, Ludwig S, eds. Child Abuse: Medical Diagnosis and Management. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:157\u2013176"},{"key":"2021120905220525000_R5","doi-asserted-by":"crossref","unstructured":"Jenny C. American Academy of Pediatrics, Committee on Child Abuse and Neglect. Evaluating infants and young children with multiple fractures. Pediatrics.\u20082006;118(3):1299\u20131303","DOI":"10.1542\/peds.2006-1795"},{"key":"2021120905220525000_R6","unstructured":"Alexander RC, Levitt CJ, Smith WL. Abusive head trauma. In: Reece RM, Ludwig S, eds. Child Abuse: Medical Diagnosis and Management. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:47\u201380"},{"key":"2021120905220525000_R7","doi-asserted-by":"crossref","unstructured":"Trokel M, DiScala C, Terrin NC, Sege RD. Blunt abdominal injury in the young pediatric patient: child abuse and patient outcomes. Child Maltreat.\u20082004;9(1):111\u2013117","DOI":"10.1177\/1077559503260310"},{"key":"2021120905220525000_R8","doi-asserted-by":"crossref","unstructured":"Canty TG, Canty TG Jr, Brown C. Injuries of the gastrointestinal tract from blunt trauma in children: a 12-year experience at a designated pediatric trauma center. J Trauma.\u20081999;46(2):234\u2013240","DOI":"10.1097\/00005373-199902000-00005"},{"key":"2021120905220525000_R9","doi-asserted-by":"crossref","unstructured":"Cooper A, Floyd T, Barlow B, et al. Major blunt abdominal trauma due to child abuse. J Trauma.\u20081988;28(10):1483\u20131487","DOI":"10.1097\/00005373-198810000-00015"},{"key":"2021120905220525000_R10","doi-asserted-by":"crossref","unstructured":"Sung CK, Kim KH. Missed injuries in abdominal trauma. J Trauma.\u20081996;41(2):276\u2013282","DOI":"10.1097\/00005373-199608000-00013"},{"key":"2021120905220525000_R11","doi-asserted-by":"crossref","unstructured":"Ola\u0301h A, Issekutz A, Haulik L, Makay R. Pancreatic transaction from blunt abdominal trauma: early versus delayed diagnosis and surgical management. Digest Surg.\u20082003;20(5):408\u2013414","DOI":"10.1159\/000072708"},{"key":"2021120905220525000_R12","doi-asserted-by":"crossref","unstructured":"Oztu\u0308rk H, Onen A, Otc\u0327u S, et al. Diagnostic delay increases morbidity in children with gastrointestinal perforation from blunt abdominal trauma. Surg Today.\u20082003;33(3):178\u2013182","DOI":"10.1007\/s005950300040"},{"key":"2021120905220525000_R13","doi-asserted-by":"crossref","unstructured":"Barnes PM, Norton CM, Dunstan FD, Kemp AM, Yates DW, Sibert JR. Abdominal injury due to child abuse. Lancet.\u20082005;366(9481):234\u2013235","DOI":"10.1016\/S0140-6736(05)66913-9"},{"key":"2021120905220525000_R14","doi-asserted-by":"crossref","unstructured":"Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY: Wiley; 1989","DOI":"10.2307\/2531779"},{"key":"2021120905220525000_R15","doi-asserted-by":"crossref","unstructured":"Isaacman DJ, Scarfone RJ, Kost SI, et al. Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient. Pediatrics.\u20081993;92(5):691\u2013694","DOI":"10.1542\/peds.92.5.691"},{"key":"2021120905220525000_R16","doi-asserted-by":"crossref","unstructured":"Hennes HM, Smith DS, Schneider K, et al. Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury. Pediatrics.\u20081990;86(1):87\u201390","DOI":"10.1542\/peds.86.1.87"},{"key":"2021120905220525000_R17","doi-asserted-by":"crossref","unstructured":"Oldham KT, Guice KS, Kaufman RA, Martin LW, Noseworthy J. Blunt hepatic injury and elevated hepatic enzymes: a clinical correlation in children. J Pediatr Surg.\u20081984;19(4):457\u2013461","DOI":"10.1016\/S0022-3468(84)80275-4"},{"key":"2021120905220525000_R18","doi-asserted-by":"crossref","unstructured":"Puranik SR, Hayes JS, Long J, Mata M. Liver enzymes as predictors of liver damage due to blunt abdominal trauma in children. South Med J.\u20082002;95(2):203\u2013206","DOI":"10.1097\/00007611-200295020-00010"},{"key":"2021120905220525000_R19","doi-asserted-by":"crossref","unstructured":"Karam O, La Scala G, Le Coultre C, Chardot C. Liver function tests in children with blunt abdominal traumas. Eur J Pediatr Surg.\u20082007;17(5):313\u2013316","DOI":"10.1055\/s-2007-965533"},{"key":"2021120905220525000_R20","doi-asserted-by":"crossref","unstructured":"Rathaus V, Zissin R, Werner M, et al. Minimal pelvic fluid in blunt abdominal trauma in children: the significance of this sonographic finding. J Pediatr Surg.\u20082001;36(9):1387\u20131389","DOI":"10.1053\/jpsu.2001.26377"},{"key":"2021120905220525000_R21","unstructured":"Udekwu PO, Gurkin B. The use of computed tomography in blunt abdominal injuries. Am Surg.\u20081996;62(1):56\u201360"},{"key":"2021120905220525000_R22","doi-asserted-by":"crossref","unstructured":"Benya EC, Lim-Dunham JE, Landrum O, Statter M. Abdominal sonography in examination of children with blunt abdominal trauma. AJR Am J Roentgenol.\u20082000;174(6):1613\u20131616","DOI":"10.2214\/ajr.174.6.1741613"},{"key":"2021120905220525000_R23","doi-asserted-by":"crossref","unstructured":"Tas\u0327 F, Ceran C, Atalar MH, Bulut S, Selbes\u0327 B, Is\u0327ik AO. The efficacy of ultrasonography in hemodynamically stable children with blunt abdominal trauma: a prospective comparison with computed tomography. Eur J Radiol.\u20082004;51(1):91\u201396","DOI":"10.1016\/S0720-048X(03)00145-1"},{"key":"2021120905220525000_R24","unstructured":"Rosenthal P, Jennings MT. Comparison of fecal occult blood tests for detection of gastrointestinal bleeding in pediatric patients. Am J Gastroenterol.\u20081992;87(11):1575\u20131579"},{"key":"2021120905220525000_R25","doi-asserted-by":"crossref","unstructured":"Harewood GC, McConnell JP, Harrington JJ, Mahoney DW, Ahlquist DA. Detection of occult upper gastrointestinal tract bleeding: performance differences in fecal occult blood tests. Mayo Clin Proc.\u20082002;77(1):23\u201328","DOI":"10.4065\/77.1.23"},{"key":"2021120905220525000_R26","doi-asserted-by":"crossref","unstructured":"Brown SL, Haas C, Dinchman KH, et al. Radiologic evaluation of pediatric blunt renal trauma in patients with microscopic hematuria. World J Surg.\u20082001;25(12):1557\u20131560","DOI":"10.1007\/s00268-001-0149-6"},{"key":"2021120905220525000_R27","doi-asserted-by":"crossref","unstructured":"Holmes JF, Sokolove PE, Lane C, Kuppermann N. Identification of intra-abdominal injuries in children hospitalized following blunt abdominal trauma. Acad Emerg Med.\u20081999;6(8):799\u2013806","DOI":"10.1111\/j.1553-2712.1999.tb01210.x"},{"key":"2021120905220525000_R28","doi-asserted-by":"crossref","unstructured":"Taylor GA, Eichelberger MR, Potter BM. Hematuria: a marker of abdominal injury in children after blunt trauma. Ann Surg.\u20081988;208(6):688\u2013693","DOI":"10.1097\/00000658-198812000-00003"},{"key":"2021120905220525000_R29","doi-asserted-by":"crossref","unstructured":"Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA.\u20081999;281(7):621\u2013626","DOI":"10.1001\/jama.281.7.621"},{"key":"2021120905220525000_R30","doi-asserted-by":"crossref","unstructured":"Lane WG, Rubin D, Monteith R, Christian CW. Racial differences in the evaluation of pediatric fractures for physical abuse. JAMA.\u20082002;288(13):1603\u20131609","DOI":"10.1001\/jama.288.13.1603"},{"key":"2021120905220525000_R31","doi-asserted-by":"crossref","unstructured":"Lane WG, Dubowitz H. What factors affect the identification and reporting of child abuse-related fractures?Clin Orthop Relat Res.\u20082007;461:219\u2013225","DOI":"10.1097\/BLO.0b013e31805c0849"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/6\/1595\/1022398\/zpe01209001595.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/6\/1595\/1022398\/zpe01209001595.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T17:05:59Z","timestamp":1685207159000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/124\/6\/1595\/72210\/Screening-for-Occult-Abdominal-Trauma-in-Children"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,12,1]]},"references-count":31,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2009,12,1]]},"published-print":{"date-parts":[[2009,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2009-0904","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,12,1]]}}}