Duodenal Injuries in Children: Beware of Child Abuse

Barbara A. Gaines, Barbara S. Shultz, Katie Morrison, Henri Ford

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Purpose: It is frequently overlooked that child abuse may result in significant intraabdominal injury, particularly to the duodenum. The authors hypothesized that a significant number of duodenal injuries in young children would be the result of nonaccidental trauma. Methods: An 8-year (1995 through 2002) retrospective review of a pediatric level I trauma center database was performed after Institutional Review Board approval was obtained, and information regarding patients with duodenal injury was abstracted. Demographic variables, injury severity, length of stay, mortality rate, and mechanism of injury were examined. Statistical analysis was performed using descriptive statistics and Student's t test. Statistical significance was defined as P less than .05. Results: Over the 8-year study period, 8,968 patients were admitted, 2,179 (24%) were less than 3 years of age. Thirty children (0.3%) suffered injury to the duodenum, with 20 hematomas and 10 perforations. Patients were overwhelmingly boys (80%), with an average age of 7.6 ± 4.4 years and Injury Severity Score (ISS) of 14 ± 10. No patients died. Children were injured by a variety of mechanisms, including collisions involving motor vehicles (n = 9), bicycles (n = 4), and ATVs (n = 2). However, all children less than 4 years of age (n = 8) were victims of nonaccidental trauma, 2.8% of all child abuse admissions. Three of these children suffered perforations of the duodenum. Among the entire population, those children who suffered perforations had a significantly higher ISS (23.7 ± 7.2 v 9.6 ± 7.3; P < .0003) and longer length of stay (27.1 ± 15.3 v 12.6 ± 11.7; P < .007) than those with hematomas Conclusions: Injury to the duodenum is unusual in the pediatric trauma patient but does result in significant injury severity and prolonged hospitalization. In the young child, one must maintain a high index of suspicion regarding the etiology of the injury, because a large percentage is potentially the result of child abuse.

Original languageEnglish (US)
Pages (from-to)600-602
Number of pages3
JournalJournal of Pediatric Surgery
Volume39
Issue number4
DOIs
StatePublished - Jan 1 2004
Externally publishedYes

Fingerprint

Child Abuse
Wounds and Injuries
Duodenum
Injury Severity Score
Hematoma
Length of Stay
Pediatrics
Trauma Centers
Research Ethics Committees
Motor Vehicles
Hospitalization
Demography
Databases
Students

Keywords

  • Blunt duodenal trauma
  • Child abuse
  • Duodenal perforation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Duodenal Injuries in Children : Beware of Child Abuse. / Gaines, Barbara A.; Shultz, Barbara S.; Morrison, Katie; Ford, Henri.

In: Journal of Pediatric Surgery, Vol. 39, No. 4, 01.01.2004, p. 600-602.

Research output: Contribution to journalArticle

Gaines, Barbara A. ; Shultz, Barbara S. ; Morrison, Katie ; Ford, Henri. / Duodenal Injuries in Children : Beware of Child Abuse. In: Journal of Pediatric Surgery. 2004 ; Vol. 39, No. 4. pp. 600-602.
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