Recognizing Child Abuse in Radiology

105 Pages·2017·4.9 MB·English

by  Alan E. Oestreich

Recognizing
Child Abuse in
Radiology
Alan E. Oestreich
Marguerite M. Caré
123
Recognizing Child Abuse in Radiology

Alan E. Oestreich (cid:129) Marguerite M. Caré
Recognizing Child Abuse
in Radiology
Alan E. Oestreich Marguerite M. Caré
Department of Radiology ML5031 Department of Radiology ML5031
Cincinnati Children’s Hospital Cincinnati Children’s Hospital
Cincinnati Cincinnati
Ohio Ohio
USA USA
ISBN 978-3-319-44322-5 ISBN 978-3-319-44324-9 (eBook)
DOI 10.1007/978-3-319-44324-9
Library of Congress Control Number: 2016953298
© Springer International Publishing Switzerland 2017
T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
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Printed on acid-free paper
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The registered company is Springer International Publishing AG Switzerland
To
Our families
And
In the hope that this book may benefi t all vulnerable
families

Foreword
The child abuse physician’s task is to identify those children who have been victims
of child abuse and to then coordinate a multidisciplinary response needed to protect
them from further harm. Most cases of suspected child abuse lack a gold standard
diagnostic test, but we have learned that accurate determination of abuse can be
made through a tight collaboration between skilled clinicians, radiologists, and
community protective investigators.
The radiologic evaluation for child abuse is unlike any other clinical scenario.
Most of the children evaluated for suspected physical child abuse are too young to
tell their story, may fi rst come to our attention following a delay in medical care, and
present to us with confl icting histories told by caregivers. Often the clinical history
is either entirely lacking or we believe it to be completely false. Thus, radiographic
interpretation of suspected trauma is hindered by the absence of a reliable history
and often the lack of physical disability or cutaneous signs of injury. Not only are
these conditions challenging to the radiologist, but unconscious bias can also affect
our assumptions and interpretation.
The authors of this book have been active members of the Cincinnati Children’s
Child Abuse Team for decades and have interpreted the fi lms of thousands of chil-
dren for whom child abuse was suspected. They have participated in weekly multi-
disciplinary case discussions, demonstrated radiographic fi ndings, and taught using
language that is accessible to nonmedical investigators. Drs. Oestreich and Caré are
experts in threading their way within uncertainty, informing about their level of
certainty and the timing of injuries while avoiding at times the excessive demands
of police offi cers and prosecutors for answers.
T his book is intended to share this learned wisdom with other radiologists, as
well as other interested health care practitioners including us child abuse pediatri-
cians. The informed interpretation and opinions of the radiologist are critical to the
recognition and protection of abused children. Not only must we accurately diag-
nose child abuse to protect children from imminent harm or death but child abuse is
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viii Foreword
a leading risk factor for developmental delay, child and adult mental and physical
illness, and shortened life expectancy. This text will improve our capacity to change
the outcome for many families and children.
Robert A. Shapiro, M.D.
Division Director
Mayerson Center for Safe and Healthy Children
Cincinnati, Ohio
Clinical Professor of Pediatrics
University of Cincinnati College of Medicine
Pref ace
The authors welcome their readers to this book intended to highlight imaging fi nd-
ings in children who may be victims of child abuse, previously suspected or not, as
well as imaging fi ndings that might be confused with child abuse, either normal or
due to other conditions. Emphasis is on our personal experience over many years, as
well as selected pertinent readings in the literature. We hope this approach will
supplement and provide some additional insights to the more comprehensive larger
works on these topics.
Alan Oestreich, M.D., is the author of Chaps. 1 , 2 , 3 , 4 , 5 and 8 , while Marguerite
M. Caré, M.D., is the author of Chaps. 6 and 7 . Both are pediatric radiologists, and
she is also a pediatric neuroradiologist.
T he authors thank Glenn Miñano for assistance with image preparation, Joanne
(Toni) Lovelace and Kathy Umberg for secretarial assistance, and our colleagues in
the Cincinnati Children’s Hospital Child Abuse Team and the Department of
Radiology for years of collaboration and support.
AEO and MMC
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