Small-bowel injuries are more common in abused children but can arise accidentally as a result of falls or road-traffic accidents, according to a research letter in this week’s issue of The Lancet.
Published work on the cause of abdominal injury is limited. This paucity of data may make if difficult to distinguish between accidental injury and abuse at first referral, throughout clinical care, and in the courts.
Between March 2001 and February 2003 Jonathan Sibert (Cardiff University, UK) and colleagues looked at the incidence of abdominal injury due to abuse in children aged 0–14 years that had been confirmed by a multidisciplinary meeting and reported through the British Paediatric Surveillance Unit (BPSU). The researchers compared the pattern of injury in the abused children with that of children aged 0–14 years on the Trauma Audit and Research Network (TARN), who had abdominal injuries from road traffic accidents or falls. The TARN gathers comprehensive injury details from a large group of trauma-receiving hospitals in the UK. 20 children had abdominal injuries due to abuse and 164 had injuries to the abdomen due to an accident (112 road-traffic accidents, 52 by falls). The researchers found that the incidence of abdominal injury due to abuse was 0·90 cases per million children per year in those aged 0- 14 years and 2.33 cases per million children per year in those younger than 5 years. Children who had been abused were twice as likely to have a gut injury when compared with children in a road-traffic accident and nearly six times more likely to have a gut injury when compared with children injured by a fall. No children under five sustained a gut injury from a fall.
Professor Sibert comments: “Abdominal injury is a rare but serious form of abuse. We cannot rely on abdominal bruising alone to make the diagnosis of abuse because a quarter of children did not have that sign. We suggest paediatricians should look more closely at children suspected of being abused to exclude intra-abdominal injury. We have shown that small bowel injury can occur accidentally from road traffic accidents or falls but it is more common in abused children. Injuries to the small bowel need special consideration especially if the child is under five and a fall is the explanation.”