Hallmarks of Non-accidental Trauma: A Surgeon's Perspective

Child abuse is a public health epidemic in the United States with high incidence, prevalence, and severe personal and societal impact. Surgeons should be considering child abuse in their treatment of children with traumatic injury. Screening for child abuse mechanism in the ED and in-patient settings is not precise, subject to bias and often incomplete. A variety of tools and factors have been studied for their predictive potential despite inherent methodological issues; thus, no one screening tool has been proposed as the standard of care. More research is warranted to better define how to best screen patients for the need for further child abuse investigation. Given the accumulative impact of ionizing radiation with children, the utilization of unnecessary CTs should be limited. For instance, the use of head CT in children suspected of inflicted head trauma should be limited; however, very few additional screening modalities exist to better identify the subset of children that need a CT. Studies on serum CSF biomarkers of head injury are promising and yet require further research in order to recommend their use in the clinical setting.