Characteristics of Pediatric Forensic Cases Caused by Blunt General Body Trauma Evaluated in the Emergency Department: A Single Center Experience

Abstract

Objective: In this study we aimed to evaluate and analyse demographic features, presentations characteristics, and management approaches in paediatric forensic cases presenting to an emergency department.

Materials and Methods: A total of 518 children aged between 0-18 years, who presented to the emergency department of hospital between 2011 and 2020 due to traffic accidents, falls and violence, were included. Demographic information such as age, gender, reason for admission, time of admission, diagnosis, body region of the injury, and consultation and treatment results were included in the study.

Results: The median age was 12 years and 67.6% were boys. The median age was significantly lower in the patients who presented due to falls. The patients most presented to the emergency department in the summer months (August) and on Saturdays. The most diagnosis was in soft tissue injury (STI) (50.6%), followed by bone fracture / dislocation injury (42.1%). STI was higher in the violence group compared to others. The most injured body part was the head/neck region (37.8%). The most consulted department was neurosurgery (39.4%). The mortality rate was 4.4%.

Conclusion: For emergency specialists, it is important to have sufficient information about demographic and clinical features of paediatric forensic patients for a more efficient physical examination and management.  

Keywords

• Falls
• Forensic cases
• paediatrics
• traffic accidents
• violence

Acil Serviste Değerlendirilen Künt Genel Vücut Travmasının Neden Olduğu Pediatrik Adli Vakaların Özellikleri: Tek Merkez Deneyimi

Öz

Amaç: Bu çalışmada, acil servise başvuran çocuk adli olguların demografik özellikleri, başvuru özellikleri ve yönetim yaklaşımlarını değerlendirmeyi ve analiz etmeyi amaçladık.

Materyal ve Metot: 2011-2020 yılları arasında hastanemiz acil servisine trafik kazası, düşme ve şiddet nedeniyle başvuran 0-18 yaş arası toplam 518 çocuk çalışmaya dahil edildi. Hastaların yaşı, cinsiyeti, başvuru nedeni, başvuru zamanı, tanısı, yaralanmanın vücut bölgesi gibi demografik bilgiler ile birlikte konsültasyon ve tedavi sonuçları çalışmaya dahil edildi.

Bulgular: Hastaların ortanca yaşı 12 (dağılım: 6-16) ve 350'si (%67,6) erkekti. Düşme nedeniyle başvuran hastalarda ortanca yaş anlamlı olarak daha düşüktü. Hastaların acil servise en sık yaz aylarında (ağustos) ve cumartesi günleri başvurduğu saptandı. En sık genel tanı; yumuşak doku yaralanması (YDY) iken (%50,6) bunu kırık ve çıkıklar (%42,1) izlemekteydi. YDY; şiddet grubunda diğerlerine göre anlamlı olarak daha yüksek olduğu görüldü (her ikisi de, p<0,001). En sık yaralanan vücut bölgesi baş/boyun bölgesi (%37,8) idi ve bunu ekstremiteler izledi. En sık konsülte edilen bölüm beyin cerrahisi olarak bulundu (%39,4). Çalışmamızda mortalite oranı %4,4 idi.

Sonuç: Acil servis uzmanları için adli tıp hastalarının demografik ve klinik özellikleri hakkında yeterli bilgiye sahip olmak daha etkin bir fizik muayene ve tedavi için önemlidir. 

Anahtar Kelimeler

• düşme
• trafik kazası
• şiddet
• Adli vaka
• pediatri

References

1. Oner S, Harmanogullari LU, Yapici G. Evaluation of forensic cases admitted to the paediatric emergency service of a hospital. Ejpmr. 2017;4(8):90-95.
2. Sever M, Saz EU, Koşargelir M. An evaluation of the paediatric medico-legal admissions to a tertiary hospital emergency department. Ulus Travma Acil Cerrahi Dergisi. 2010;16(3):260-267.
3. Mace SE, Gerardi MJ, Dietrich AM, at al. Injury prevention and control in children. Ann Emerg Med. 2001;38(4):405-414.
4. Smith A. Nonaccidental injury in childhood. Aust Fam Physician. 2011;40(11):858-861.
5. Gökçen C, Dursun OB. Bir eğitim hastanesi çocuk psikiyatri birimine gönderilen adli olguların incelenmesi/Evaluation of forensic cases referred to the child psychiatry clinic of a research hospital. Dusunen Adam J Psychiatry Neurol Sci. 2012;25(3):238–243.
6. Feury KJ. Injury prevention. Where are the resources? Orthop Nurs. 2003;22(2):124-130.
7. Duramaz BB, Yıldırım HM, Kıhtır HS, Yeşilbaş O, Şevketoğlu E. Evaluation of forensic cases admitted to paediatric intensive care unit. Turk Pediatri Ars. 2015;50(3):145-150
8. Offiah A, van Rijn RR, Perez-Rossello JM, Kleinman PK. Skeletal imaging of child abuse (non-accidental injury). Pediatr Radiol. 2009;39(5):461-470.

9. Jewkes R, Christofides N, Vetten L, Jina R, Sigsworth R, Loots L. Medico-legal findings, legal case progression, and outcomes in South African rape cases: retrospective review. PLoS Med. 2009;6(10). doi:10.1371/journal.pmed.1000164
10. Altintop I, Kaynak MF, Altuntas M, Yilmaz M, Vural A, Yurtseven A. An evaluation of paediatric forensic trauma cases: a retrospective study. J Turgut Ozal Med Cent. 2016;23(2):177-180.
11. Demir OF, Aydin K, Turan F et al. Analysis of paediatric forensic cases presented to emergency department. Turk Arch Ped. 2013;49(4):235-240.
12. Büken E, Yaşar ZF. Assessment of forensic children cases applying to the emergency service of Başkent University Ankara Hospital. Adli Tıp Bülteni. 2015;20(2):93-98.
13. Demircan A, Keleş A, Guerbuez N, et al. "Forensic emergency medicine-six-year experience of 13823 cases in a university emergency department." Turkish journal of medical sciences. 2008;38(6):567-575.
14. Polat S, Terece C, Yaman A, Gurpinar K. Evaluation of Forensic Cases in the Pediatric Intensive Care Unit. Sisli Etfal Hastanesi Tip Bul. 2021;55(1):122-127.
15. Ozdemir AA, Ergormus Y, Cag Y. Evaluation of The Pediatric Forensic Cases Admitted to Emergency Department. Int J Basic Clin Med. 2016;4(1):1-8.
16. Korkmaz T, Erkol Z, Kahramansoy N. Evaluation of paediatric forensic cases in emergency department: a retrospective study. Med Bull Haseki. 2014;52(4):271–277.
17. Anıl M, Anıl AB, Köse E et al. The evaluation of the patients admitted to the paediatric emergency department in a training and research hospital. J Pediatr Emerg Intens Care Med. 2014;1(2):65–71.
18. Amanullah S, Heneghan JA, Steele DW, Mello MJ, Linakis JG. Emergency Department Visits Resulting From Intentional Injury In and Out of School. Pediatrics. 2014;133(2):254–261.
19. Çınar O, Acar YA, Çevik E ve ark. Acil Servise Başvuran 0-18 Yaş Grubu Adli Olguların Özellikleri. AJCI. 2010;4(3):148-151.
20. Türe E, Erarslan E, Yazar A, Akın F, Odabaş D. Evaluation of Clinical and Demographical Characteristics of the Patients who Admitted to the Pediatric Emergency Department of a University Hospital. Haydarpasa Numune Med J. 2020;60(3):292-299.
21. Kadioglu E. Pediatric forensic cases: An emergency department experience. J For Med. 2018;32(1):1-9.
22. Kang MS, Kim HS. Characteristics and trends of traumatic injuries in children visiting emergency departments in South Korea: A retrospective serial cross-sectional study using both nationwide-sample and single-institutional data. PLoS One. 2019;14(8). doi:10.1371/journal.pone.0220798
23. Ayaz N, Turgut K, Turtay MG et al. Evaluation of home accidents of forensic nature among children. Medicine Science. 2020;9(4):1032-1035.