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April 12, 2000

Child Abuse Is Deadlier Than Accidents

Researchers Tell Cops to Look Out for Signs

By Deborah Wormser, APB News

BOSTON (APBnews.com) -- Injuries deliberately inflicted on a child are more likely to be fatal than accidental injuries, according to studies involving thousands of children nationwide.

Researchers found that certain physical signs are far more common in abused children than those injured in accidents. Two new studies could aid investigators and prevent future abuse, said Dr. Robert Sege, an associate professor of pediatrics at Tufts University and co-author of both studies.

"Once a child's been injured by abuse, they're obviously at very high risk for subsequent abuse if they go back to the same home," he said.

The largest study ever done on child abuse analyzed data on more than 18,000 children treated for blunt trauma at more than 80 medical centers across the United States from 1988 to 1997. The cases came from the National Pediatric Trauma Registry, which is directed by the study's lead author, Carla DiScala.

Battering and shaking

The second study, written by Sege and lead author Dr. Robert M. Reece, studied 287 consecutive head injuries in children under age 6 1/2 who were treated at Rainbow Children's Hospital in Cleveland.

Both studies were published in the January edition of Archives of Adolescent and Pediatric Medicine.

"One of our most significant findings is the very high percentage of children 4 years or younger admitted to the hospital for child abuse," said DiScala, who is an assistant professor of pediatrics at Tufts. "Close to 11 percent of children who are admitted to the hospital with blunt trauma are victims of child abuse."

Her study found that children injured by abuse were considerably younger, 12.8 months, compared with those whose injuries were accidental -- 25.5 months. Abused children, who were mainly hurt by battering and shaking, were hospitalized an average of nine days, more than twice as long as the four days on average for unintentionally injured children, who were hurt mainly in falls and motor vehicle-related events.

Bleeding at back of eye

Certain injuries clustered in the abused group, most notably retinal hemorrhage -- bleeding at the back of the eye -- can only be viewed through a tool called an ophthalmoscope. Nearly 29 percent of the abused children in DiScala's study suffered retinal hemorrhage, compared with less than a tenth of a percent of those who were unintentionally injured.

There has been controversy over the cause of retinal hemorrhage, with at least one study suggesting that cardiopulmonary resuscitation might be responsible for it, DiScala explained.

These two studies should put that controversy to rest, Sege said. In his head injury study, only a handful of the unintentionally injured children had retinal hemorrhage. Those cases included one child who was shot in the face and another who fell more than two stories onto a hard surface.

Nearly one in five, or 19 percent, of the head injuries treated at the Ohio hospital were caused by abuse, and the abused children's injuries were more severe, Sege said. Bleeding in the brain, which can cause permanent disability, was four times more common in that group than in the unintentionally injured group.

Measure height of fall quickly

Authorities should measure the height of a child's alleged fall as soon as possible if he or she has suffered a severe head injury, Sege said. These studies show that falls from a distance of less than four feet tend not to cause bleeding inside the skull.

"If the history is inconsistent or changes with time, that is a classic sign that the child may have been abused," Sege said.

Laws in all 50 states require health-care workers to report suspected child abuse, but many hesitate to report cases about which they are uncertain. The researchers said they hoped these studies would resolve the uncertainty.

The DiScala study provides a wealth of information for child abuse investigations because of its size and its objectivity, he said.

"This represents 10 years of data collected by trauma surgeons on children who appeared at medical centers around the country," he said.

Deborah Wormser is an APBnews.com correspondent in Dallas.

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