Development of a Surrogate Bruising Detection System to Describe Bruising Patterns Associated with Common Childhood Falls, Final Report.

摘要

Child abuse is a leading cause of trauma-related fatality in children 0-4 years of age (DHHS, 2006). Roughly 1500 children are fatally injured each year in association with child abuse and 150,000 are permanently disabled (DHHS, 2006). Fatalities were greatest amongst children 1 year of age and younger. Many serious injuries and fatalities could have been prevented if clinicians and child protective services were able to better distinguish between those injuries associated with abuse and those injuries caused by accidents. Clinicians, child protective services and law enforcement personnel would greatly benefit from knowledge related to the types of injuries that are truly possible from common household accidents often reported to be the underlying cause of injury in child abuse. Knowledge of the type of injuries that can result from common household accidents can equip personnel responsible for distinguishing between abusive and accidental injuries with information that is key to decision-making. Although not life threatening injuries, bruising patterns provide a roadmap documenting a childs exposure to violence or a simple childhood fall. That is, for each and every substantial impact to the childs body, a resulting soft tissue injury will likely develop. Previous studies have shown that bruising patterns resulting from abuse are significantly different than those resulting from accidents (Atwal, 1998; Dunstan, 2002; Pierce, 2010). This distinguishing feature of abuse is often overlooked in the clinical setting, as well as in forensic investigations. In a forensic investigation of physical child abuse, a childs bruising roadmap can permit engineers to evaluate the compatibility of the biodynamics of the stated cause (e.g. stairfall or bed fall) and the presenting soft tissue injuries. Failure to verify biodynamic compatibility between the bruising pattern and stated cause should raise questions regarding the veracity of the provided history. It is this evaluation of biodynamic compatibility based upon the bruising roadmap that our study aimed to address.