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Clues That Aid in the Diagnosis of Nonaccidental Trauma Presenting as an Apparent Life-Threatening Event

Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, kishore.vellody{at}chp.edu

Jennifer P. Freeto, MD

Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Sandra L. Gage, MD

Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Nicole Collins, MD

Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin

William M. Gershan, MD

Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Background Apparent life-threatening events (ALTEs) can encompass many different diagnoses. Nonaccidental trauma (NAT) is one potential serious diagnosis.

Objective (1) To identify key elements in the history and physical exam in infants presenting with an ALTE that aid in the subsequent diagnosis of NAT; and (2) to evaluate the role of diagnostic studies in these infants in confirming the diagnosis of NAT.

Design/Methods A retrospective chart review analysis, over a 2-year period, of infants with an ALTE was performed. From this group, all children with a discharge diagnosis of child physical abuse, shaken infant syndrome, or NAT were included in the study.

Results 4 patients were found to be victims of NAT based on their clinical histories and physical examinations. Although confirmatory, ophthalmologic exams, skeletal surveys, and head CT scans had a lower sensitivity for NAT.

Conclusions NAT should be considered when an infant is admitted for evaluation of an ALTE.

Key Words: apparent life-threatening events • nonaccidental trauma • child abuse

This version was published on November 1, 2008

Clinical Pediatrics, Vol. 47, No. 9, 912-918 (2008)
DOI: 10.1177/0009922808320595


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