Abstract
Child abuse is a topical issue in modern society and has social and medical implications which directly concern the doctor, both as a private citizen and as a health professional. Abuse injuries can be of very different types, e.g. physical, psychological or sexual. Hence they require a multidisciplinary and multispecialty approach, which must begin with an accurate medical examination, conducted in compliance with the lege artis principles and with respect for the victim’s dignity. Diagnostic imaging becomes essential, together with epicrisis, which is useful to distinguish between accidental and abusive injuries. This paper describes the radiologist’s key role in identifying physical injuries due to child abuse, in accordance with current regulations.
Riassunto
L’abuso ed il maltrattamento sui minori è una tematica di grande attualità con notevoli risvolti di carattere sociosanitario che interessano il medico sia come cittadino che in qualità di esercente una professione sanitaria. La molteplicità e la peculiarità di alcune lesività di abuso, siano queste di tipo fisico, psichico o sessuale necessitano di un approccio multidisciplinare e polispecialistico che non può prescindere tuttavia da una visita medica che, nel rispetto della dignità della presunta vittima, sia effettuata secondo i criteri propri della lege artis. A tale fine grande importanza assumerà l’imaging radiodiagnostico e la conseguente epicrisi utile a distinguere una lesione accidentale da quella da abuso. Il presente articolo descrive il ruolo del radiologo nella valutazione degli abusi fisici perpetrati a danno di minori alla luce della normativa vigente.
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References/Bibliografia
Caffey J (1946) Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. AJR Am J Roentgenol 56:163–173
World Health Organization (2002) World report on violence and health. WHO, Genova
Introna F (2005) Gli obblighi giuridici del pediatra di fronte al bambino maltrattato, al minore abusato, all’incesto e altro. Zacchia 78:1–20
Introna F (2002) La violenza in famiglia. Riv It Med Leg 24:1317–1325
Caffey J (1957) Some traumatic lesions in growing bones other than fractures and dislocations, clinical and radiological features. Br J Radiol 30:225–229
Kempe CH, Silverman FN, Steele BF et al (1962) The battered-child syndrome. JAMA 181:17–24
Caffey J (1972) The parent-infant traumatic stress syndrome (battered baby syndrome). AJR Am J Roentgenol 114:217–225
Silverman F (1972) Unrecognized trauma in infants, the battered child syndrome. Radiology 104:337–339
Drvaric DM, Morrell SM, Wyly JB et al (1992) Fracture patterns in the battered child syndrome. J South Orthop Assn 1:20–25
Kleinman PK, Marks SC, Blackbourne B (1986) The metaphyseal lesion in abused infants: a radiologichistopathologic study. AJR Am J Roentgenol 146:895–905
Kleinman PK, Marks SC (1995) Relationship of the subperiosteal bone collar to metaphyseal lesions in abused infants. J Bone Joint Surg Am 77:1471–1476
Tenenbein M, Reed MH, Black GB (1990) The toddler’s fracture revisited. Am J Emerg Med 8:208–214
Sarmah A (1995) ‘Toddler’s fracture’? A recognised entity. Arch Dis Child 72:376–378
Kleinman PK (1999) Occult hyperextension “toddler’s” fracture by Swischuk, et al. Pediatr Radiol 29:720
Feldman KW, Brewer DK (1984) Child abuse, cardiopulmonary resuscitation, and rib fractures. Pediatrics 73:339–342
Kleinman PK, Marks SC, Spevak MR et al (1992) Fractures of the rib head in abused infants. Radiology 185:119–123
Kleinman PK, Marks SC Jr, Nimkin K et al (1996) Rib fractures in 31 abused infants: postmortem radiologichistopathologic study. Radiology 200:807–810
Strouse PJ, Owings CL (1995) Fractures of the first rib in child abuse. Radiology 197:763–765
Conway JJ, Collins M, Tanz RR et al (1993) The role of bone scintigraphy in detecting child abuse. Semin Nucl Med 23:321–333
Mandelstam SA, Cook D, Fitzgerald M et al (2003) Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child 88:387–390
Pickett WJ, Faleski EJ, Chacko A et al (1983) Comparison of radiographic and radionuclide skeletal surveys in battered children. South Med J 76:207–212
Case ME (2007) Abusive head injuries in infants and young children. Leg Med (Tokyo) 9:83–87
Tung GA, Kumar M, Richardson RC et al (2006) Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 118:626–633
Guthkelch AN (1995) The shaken infant syndrome. Serious effects of shaking were described in 1971. BMJ 310:1600
Case ME, Graham MA, Handy TC et al (2001) National Association of Medical Examiners Ad Hoc Committee on Shaken Baby Syndrome: position paper on fatal abusive head injuries in infants and young children. Am J Forensic Med Pathol 22:112–122
Duhaime AC, Gennarelli TA, Thibault LE et al (1987) The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66:409–415
Case ME, Nanduri R (1983) Laceration of the stomach by blunt trauma in a child: a case of child abuse. J Forensic Sci 28:496–501
Macchiarelli L, Albarello P, Di Luca NM, Feola T (2005) Medicina legale. Minerva Medica, Torino
Slovis TL, Smith WL, Strain JD et al (2005) Expert Panel on Pediatric Imaging. Suspected physical abusechild. American College of Radiology, Reston
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Solarino, M., De Filippi, C. & Solarino, B. Radiological and forensic medicine aspects of traumatic injuries in child abuse. Radiol med 114, 1356–1366 (2009). https://doi.org/10.1007/s11547-009-0501-8
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DOI: https://doi.org/10.1007/s11547-009-0501-8