Our efforts regarding abuse judgment for pediatric head injuries: analysis of cases involving a neurosurgeon from the time of initial treatment

<p>The Marianna Child Assault Prevention (MCAP, later renamed Marianna Committee of Abuse Prevention) Committee has been managed by clinical doctors, legal medicine doctors, nurses, and social workers to address child abuse at our hospital since 2001. In this study, we review this committee’s overview, approaches, and management toward cases of child abuse with head trauma at our hospital.</p><p>We retrospectively analyzed the medical records of cases of pediatric head injury in patients<15 years old that were admitted to our hospital between 2010 and 2019.</p><p>A total of 149 cases of head trauma were treated at our department, 18 (12.1%) of which were suspected by neurosurgeons to be cases of abusive head trauma (AHT). There was a difference in the average age between the accidental head injury (A group, 5.9 years) and suspected AHT (M group, 0.6 years) (p=0.000). Furthermore, there were statistically significant differences in the route of consultation (p=0.028), cause of injury (p=0.000), and type of injury (p=0.018) between the two groups. More cases (10/18) tended to visit the emergency center at night, and skull fracture (66.7%) and subdural hematoma (37.0%) were more common in the M group. About 40% of the cases were attributed to other reasons, including convulsions and subcutaneous hematomas noticed by individuals other than the parents. As an initiative of MCAP, the number of suspected AHT cases increased after enhancing the education for all the hospital staff and lowering the threshold for reporting. The intervention rate of MCAP was 4.2% in 2010-2016 and 26.9% in 2016-2019. Out of the 18 cases, 12 were notified to the Child-Guidance Center, and the notification rate was thus decreased from 100 to 57%. The reason for the decrease in the notification rate is that cases of neglect with the requirement of continuous childcare support have been uncovered. Moreover, neurosurgeons that are not specialized in pediatrics need to keep in mind a background of abuse, including neglect, when treating head injuries in infants. It is important to prevent new and recurrent child abuse with long-term medical and social welfare follow-up.</p>