SOFT-TISSUE INJURY AS AN INDICATION OF CHILD-ABUSE

We reviewed the hospital records of 371 children who were suspected of having been physically abused. Our purpose was to determine specific features that might be used to distinguish injuries resulting from abuse from accidental injuries. Soft-tissue injuries were found in 341 (92 per cent) of these children. Ecchymoses were most common, accounting for 555 (62 per cent) of 892 soft-tissue injuries, and very few had a suspicious pattern. Only thirty-four (9 per cent) of the children had a radiographically documented fracture, but radiography was performed for only thirty-seven (10 per cent) of the patients and it rarely was done unless a fracture was clinically obvious. The patterns of injury were age-specific. The forty-four children who were nine months old or less had an average of only one soft-tissue injury; thirty soft-tissue injuries involved the head or face, and seven (16 per cent) of the children had a burn. These children were the most severely injured: two (5 per cent) died and twenty (45 per cent) had a fracture. The sixty-one children who were ten months to two years and eleven months old had an average of two soft-tissue injuries; fifty-four soft-tissue injuries involved the head or face, and nine (15 per cent) of the children had a burn. A fracture was found in eight (13 per cent) of these children. Two hundred and sixty-six children who were three years old or more had an average of three soft-tissue injuries; 165 involved the head or face, and only six children (2 per cent) in this group had a fracture. We believe that all children who might have been abused should be examined for soft-tissue injuries. In children who are nine months old or less, any soft-tissue injury indicates possible abuse. In those who are ten months to two years and eleven months old or less, multiple soft-tissue injuries or a burn (especially if the head and face are involved) suggests the possibility of abuse. Whole-body skeletal radiographs should be made for children who are three years old. Soft-tissue injuries were frequently the only sign of abuse in children who were three years old or more. These children should be examined with skeletal radiographs when clinically indicated because of pain, swelling, or deformity.