Abuse-Related Injuries

Letters to the Editor Polytrauma in Children—Epidemiology, Acute Diagnostic Evaluation, and Treatment by Dr. med. Monica Christine Ciorba and Prof. Dr. med. Marc Maegele in issue 9/2024

We welcome the review article on pediatric polytrauma (1). We were, however, surprised not to see child abuse—especially abuse-related brain injuries—in the list of possible causes of injuries. In view of the fact that abuse-related brain injury is one of the leading causes of death after traumatic injury in the age group up to 2 years (2), this means that the present review article does not discuss a substantial part of the target group. From a medical perspective it does not seem logical to exclude the large group of abuse-related injuries only because they are not accidental—the management of severe intracranial or intra-abdominal traumatic injuries is likely to be independent of which mechanism or intention caused them.

Furthermore, and in contrast to the evidence gaps regarding pediatric polytrauma and injuries in children as described by the authors of the article, an S3 child protection guideline includes—among others—recommendations for the diagnostic evaluation and for how to approach abuse related injuries (3).

Even severe physical abuse of children is overlooked in the healthcare system or not recognized as such—this has deleterious individual consequences and incurs enormous costs to society. We should therefore call on colleagues that deal with pediatric injuries on a daily basis to be extra vigilant regarding this common cause of injuries and to initiate—where abuse is suspected—the appropriate assessment (for example, by seeking advice from a child protection group or contacting a medical child protection hotline).

DOI: 10.3238/arztebl.m2024.0145

Dr. med. Oliver Berthold

Medizinische Kinderschutzhotline, Kinderschutzambulanz,

DRK Kliniken Berlin

Prof. Dr. med. Sibylle Banaschak

Institut für Rechtsmedizin, Uniklinik Köln

Conflict of interest statement

OB’s main occupation is that of clinical team leader in the BMFSFJ funded project of the Medizinischen Kinderschutzhotline (the medical child protection hotline—a nationwide, free, 24-hour telephone counseling service funded by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ) for members of the medical profession, child and youth welfare services and family courts in suspected cases of child abuse, neglect and sexual child abuse).

SB declares that no conflict of interest exists.

References

1. Ciorba MC, Maegele M: Polytrauma in children—epidemiology, acute diagnostic evaluation, and treatment. Dtsch Arztebl Int 2024; 121: 291–7.

2. Choudhary AK, Servaes S, Slovis TL, et al.: Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 2018; 48: 1048–65.

3. AWMF: S3-Leitlinie Kindesmisshandlung, -missbrauch, -vernachlässigung unter Einbindung der Jugendhilfe und Pädagogik (Kinderschutzleitlinie). https://register.awmf.org/de/leitlinien/detail/027–069 (last accessed on 12 July 2024).