Pathophysiology/
Epidemiology
Epidemiology
What age range of children is at the greatest risk of death from NAT?
0-3 years
True or False: A 4-month-old comes in with a femur fracture, parents don't know how it happened and the infant does not go to daycare. A NAT work-up is not required since they don't know how it happened.
False
What imaging should be obtained to evaluate for fractures in a NAT work-up?
Skeletal survey
Abusive head trauma is linked to increased ___ impairment?
Neurological
What are some common reasons admission should be considered in a NAT patient?
Significant injury, present of occult injuries, or if a safety plan is not established
What is the estimated number of deaths per day caused by NAT?
One to two
A 4-month-old comes in with a femur fracture, parents don't know how it happened and the infant does not go to daycare. What are some important history questions to obtain on admission?
When did the injury occur?
Who was there when it occurred?
When did you first notice the injury?
Does the child go to daycare?
Who all watches the child?
How did you notice there was an injury?
True or false - If there are concerns for intra-abdominal injury, an abdominal US should be obtained.
False - Due to low sensitivity, ultrasounds are not recommended in a NAT work-up. Abdominal CT can be obtained for further evaluation.
When should a skeletal survey be repeated after the initial injury?
1 to 4 weeks
What are examples of when retinoscope images may be indicated for a patient?
When head injury occurs, shaken baby syndrome is suspected, traumas, or retinal hemorrhages
What ethnicity has the highest rate of death from NAT?
African American
What are some exam findings that are consistent with NAT?
Bruising in unusual locations, patterned bruising, bite marks, burns, facial injuries, and retinal hemorrhage
If a head CT is positive, what else should be ordered to further evaluate for injury?
Brain and spine MRI
Who should make the initial report to Child Protective Services if NAT is suspected?
First point of contact
What should be put in place when the perpetrator is not yet determined?
1:1 observation/sitter
What is the CDC estimate on how many children experience NAT?
1 in 7
Key assessment findings associated with NAT include...
Bruising, bite marks, burns, fractures, retinal hemorrhage, and subdural hematoma
If a toddler presents with altered mental status due to unknown cause and you are suspicious of a NAT, what lab would you order?
Urine drug screen
Differential diagnoses for fractures on a NAT work-up include...
Birth trauma, CPR, osteomyelitis, osteogenesis imperfecta, and congenital syphilis
Consults that are typically indicated include...
Social work, DHS referral, law enforcement, palliative care, neurosurgery, trauma, orthopedics, PT, OT, SPT
If NAT is misdiagnosed, what is the percentage of children who will experience repetitive abuse?
30-50%
The bruising guideline "TEN-4-FACESp" stands for...
TEN: torso, ears, neck
4: infants 4 months and younger with any bruise, anywhere
FACES: frenulum, angle of the jaw, cheeks, eyelids, subconjunctivae
P: pattern of bruising
What is the age at which a child must have an ophthalmology exam to assess for retinal hemorrhage in a NAT work-up?
< 12 months they must have an eye exam. An eye exam is recommended if a patient over 12 months presents with facial bruising.
A key indicator for the explanation of injury is...
The explanation of injury is inconsistent with the child's developmental abilities.
What should be included in the MRI for a stable patient with significant intracranial pathology?
Brain, cervical, thoracic, and lumbar spine MRI with and without contrast