The association of nonaccidental trauma with historical factors, examination findings, and diagnostic testing during the initial trauma evaluation

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Nonaccidental trauma (NAT) or child abuse is the deliberate or intentionally inflicted injury of a child and is a form of child maltreatment.1 One in four children experience some form of maltreatment in their lifetime.2 Annually, nearly one million children are victims of maltreatment in the United States1 at a cost of $124 billion.3 In 2014, 1,580 US children died of abuse or neglect.1,4
Children who are victims of recurrent NAT experience significantly higher mortality (25%) compared to victims of a single NAT episode (10%).5 Up to one third of children diagnosed with NAT had abuse missed on a prior presentation, and a third of those children subsequently suffered additional injuries from abuse.5–8 It is important to recognize child abuse early to avoid repeated and/or escalated injuries.1,3,4,9–11
The purpose of this article is to summarize the existing highest quality evidence on the association of various elements of history, physical examination, and diagnostic tests with a diagnosis of NAT. This summary is intended to inform the eventual development of a clinical practice guideline and highlight potential gaps in current research.
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