Challenges in the Evaluation for Possible Abuse: Presentations of Congenital Bleeding Disorders in Childhood

Autor/inn/en	Jackson, Jami; Carpenter, Shannon; Anderst, Jim
Titel	Challenges in the Evaluation for Possible Abuse: Presentations of Congenital Bleeding Disorders in Childhood
Quelle	In: Child Abuse & Neglect: The International Journal, 36 (2012) 2, S.127-134 (8 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0145-2134
DOI	10.1016/j.chiabu.2011.09.009
Schlagwörter	Children; Child Abuse; Trauma; Congenital Impairments; Diseases; Age Differences; Gender Differences; Clinical Diagnosis; Medical Evaluation + Suchen Sie Ihr Suchwort? Child; Kind; Kinder; Abuse of children; Abuse; Children; Kindesmissbrauch; Missbrauch; Disease; Krankheit; Age; Difference; Age difference; Altersunterschied; Geschlechterkonflikt
Abstract	Objectives: To describe children with congenital bleeding disorders that present in a manner that may be concerning for non-accidental trauma (NAT), and to evaluate associations with disease and demographic characteristics. Methods: Ten year retrospective charts of subjects were reviewed at a Hemophilia Treatment Center. Demographic, historical, and disease characteristics were collected. Findings were compared to a priori criteria for bleeding/bruising that is concerning for abuse. Results: Twenty-nine (15.3%) of the 189 children in the study had an initial presentation that was concerning for NAT. Of those 29, 75.9% were less than 5 years of age, 44.8% had von Willebrand disease (vWD), 51.8% had hemophilia, and 48.3% had a family history of a named bleeding disorder. Children from 9 months through 5 years of age were more likely than older children to present with findings concerning for abuse (OR 3.32, 1.21-9.10). No association was detected between presentation concerning for abuse and gender (OR 1.51, 0.6-3.77). Hemophilia was no more likely than vWD to present in a manner that was concerning for abuse (OR 0.7, 0.31-1.58). No children presented with patterned bruising. Conclusions: Children with bleeding disorders may present with bruising/bleeding that is clinically highly suggestive of NAT. Practice implications: Infants and young mobile children who have non-patterned bruising or bleeding as the only symptom concerning for abuse require an evaluation that includes testing for hemophilia and vWD. Children who have laboratory testing that indicates the presence of a bleeding disorder, but have clinical findings concerning for abuse, may benefit from a collaborative evaluation including a pediatric hematologist and a child abuse pediatrician. (Contains 1 figure and 5 tables.) (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10