Analysis of pediatric forensic cases presented to emergency department

Abstract

Aim: Emergency services are departments where forensic cases are first admitted and their examination diagnosis and treatments are performed This study aimed to evaluate demographic and epidemiologic characteristics reasons for presentation admission time and hospitalization and mortality rates in pediatric forensic cases presented to an emergency department Material and Method: Pediatric forensic cases below the age of 16 years who were admitted to an emergency department of a training research hospital within a 1 year period were evaluated retrospectively The cases were evaluated in two groups as traumatic traffic accidents assault occupational accident sharp object injury falls from high gunshot injuries and non traumatic suicide attempt carbon monoxide intoxication admissions Results: 1494 cases were included The mean age was 8 8 plusmn;4 37 years and 66 n=986 of the cases were male The majority of the cases 29 5 were in the 7 10 year age group The most common reason for presentation was traffic accident 76 4 followed by fall from high 12 7 and assault 6 1 Cases were mostly admitted in the evenings and summer months Of the cases 9 2 was hospitalized and 1 9 required intensive care unit stay; mortality rate was 0 4 Conclusions: Most forensic cases in childhood are preventable health problems Identification of forensic case profiles of each region is needed to develop new strategies take preventive measures and provide appropriate treatment approaches in emergency departments Turk Arch Ped 2013; 48: 235 240

Keywords

• Child abuse, emergency medicine, pediatric forensic, traffic accident

Acil servise başvuran çocuk adli olguların analizi

Öz

Amaç: Acil servisler adli olguların ilk başvurduğu tetkik tanı ve tedavilerinin yapıldığı yerlerdir Bu çalışmanın amacı bir eğitim araştırma hastanesi acil servisine başvuran çocuk adli olguların demografik epidemiyolojik özelliklerini ortaya koymak başvuru nedenlerini başvuru zamanlarını ve yatış ve ölüm oranlarını belirlemektir.

Gereç ve Yöntem: Bir eğitim araştırma hastanesinde acil servise bir yıl içinde başvuruda bulunan 16 yaş altı olan çocuk adli olgular geriye dönük olarak değerlendirildi Çocuk adli olgular; travmatik olan trafik kazaları darp iş kazası kesici delici alet yaralanması yüksekten düşme ateşli silah yaralanması ve diğer ve travmatik olmayan çocuk adli olgular intihar girişimi karbonmonoksit entoksikasyonu olarak iki grupta incelendi.

Bulgular: Bu çalışmada değerlendirilen 1494 çocuk adli olguların yaş ortalaması 8 8 plusmn;4 37 yıl olup bu çocuk adli olguların 66 rsquo;sı erkekti n=986 Çalışmada en fazla başvuru 7 10 yaş grubunda idi 29 5 En sık başvuru nedeni trafik kazası 76 4 olarak saptandı bunu 12 7 ile yüksekten düşme ve 6 1 ile darp izledi Çocuk adli olguların en fazla yaz aylarında ve akşam saatlerinde başvurduğu gözlendi Olguların 9 2 rsquo;sinin yatırılarak tedavi edildiği ve 1 9 rsquo;una yoğun bakım yatışı gerektiği ve ölüm oranının 0 4 olduğu saptandı.

Çıkarımlar: Çocukluk çağındaki adli olguların büyük çoğunluğu önlenebilir sağlık sorunlarıdır Yeni yöntemlerin geliştirilmesi koruyucu önlemlerin alınması ve acil servislerde uygun tıbbi yaklaşım sağlanabilmesi için her bölgenin adli olgu tutumlarının belirlenmesi önemlidir.

Anahtar Kelimeler

• Acil servis
• çocuk istismarı
• çocuk adli olgu
• trafik kazası

Kaynakça

1. De Leeuw M, Jacobs W. Forensic emergency medicine: old wine in new barrels. Eur J Emerg Med 2010; 17(4): 186-91.
2. Mace SE, Gerardi MJ, Dietrich AM, et al. Injury prevention and control in children. Ann Emerg Med 2001; 38: 405-14.
3. Sever M, Saz EU, Koşargelir M. An evaluation of the pediatric medico-legal admissions to a tertiary hospital emergency department. Ulus Travma Acil Cerrahi Derg 2010; 16(3): 260-7.
4. Feury KJ. Injury prevention. Where are the resources? Orthop Nurs 2003; 22(2): 124-30.
5. Offiah A, van Rijn RR, Perez-Rossello JM, Kleinman PK. Skeletal imaging of child abuse (non-accidental injury). Pediatr Radiol 2009; 39(5): 461-70.
6. Fernández-Rodríguez A, Ballesteros S, de Ory F, et al. Virological analysis in the diagnosis of sudden children death: a medico-legal approach. Forensic Sci Int 2006; 161(1): 8-14.
7. 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): 1000164.
8. Centers for Disease Control and Prevention. S School health guidelines to prevent unintentional injuries and violence. MMWR Recomm Rep 2001; 50(22): 1-73.

9. Töro K, Szilvia F, György D, et al. Fatal traffic injuries among children and adolescents in three cities (capital Budapest, Vilnius, and Tallinn). J Forensic Sci 2011; 56(3): 617-20.
10. Björnstig U, Björnstig J, Ahlm K, Sjögren H, Eriksson A. Violent deaths in small children in northern Sweden. Int J Circumpolar Health 2006; 65(1): 28-34.
11. Fraga AM, Fraga GP, Stanley C, Costantini TW, Coimbra R. Children at danger: injury fatalities among children in San Diego County. Eur J Epidemiol 2010; 25(3): 211-7.
12. Töro K, Szlávik N, Mészáros A, Dunay G, Soós M, Keller E. Jumping and falling death in children, adolescents, and young adults. J Clin Forensic Med 2006; 13(3): 129-34.
13. Adamsbaum C, Méjean N, Merzoug V, Rey-Salmon C. How to explore and report children with suspected non-accidental trauma. Pediatr Radiol 2010; 40(6): 932-8.
14. Santucci KA, Hsiao AL. Advances in clinical forensic medicine. Curr Opin Pediatr 2003; 15(3): 304-8.
15. Baralic I, Savic S, Alempijevic DM, Jecmenica DS, SbutegaMilosevic G, Obradovic M. Child homicide on the territory of Belgrade. Child Abuse Negl 2010; 34(12): 935-42.
16. Bandak FA. Shaken Shaken baby syndrome: a biomechanics analysis of injury mechanisms. Forensic Sci Int 2005; 151(1): 71-9. Byard RW. Forensic aspects related to pediatric pathology-Medicolegal aspects of pediatric head injuries. Keio J Med 2006; 55(4): 149-52. Demir ve ark.
17. Çocuk adli olgular/Pediatric forensic cases de Oliveira Aded NL, de Oliveira SF, da Silva Dalcin BL, de Moraes TM, Cavalcanti MT. Children and adolescents victimized by sexual abuse in the city of Rio de Janeiro: an appraisal of cases. J Forensic Leg Med 2007; 14(4): 216-20.
18. Magalhães T, Taveira F, Jardim P, Santos L, Matos E, Santos A. Sexual abuse of children. A comparative study of intra and extrafamilial cases. J Forensic Leg Med 2009; 16(8): 455-9.
19. Kennedy SP, Baraff LJ, Suddath RL, Asarnow JR. Emergency department management of suicidal adolescents. Ann Emerg Med 2004; 43(4): 452-60.
20. Wintersteen MB, Diamond GS, Fein JA. Screening for suicide risk in the pediatric emergency and acute care setting. Curr Opin Pediatr 2007; 19(4): 398-404.
21. Arslan M, Akçan R, Hilal A, Batuk H, Cekin N. Suicide among children and adolescents: data from Cukurova, Turkey. Child Psychiatry Hum Dev 2007; 38(4): 271-7.
22. Ashtekar CS, Hande A, Stallard E, Tuthill D. How much do junior staff know about common legal situations in paediatrics ? Child Care Health Dev 2007; 33(5): 631-4.
23. Wiler JL, Bailey H, Madsen TE. The need for emergency medicine resident training in forensic medicine. Ann Emerg Med 2007; 50: 733Oral R, Blum KL, Johnson C. Fractures in young children: are physicians in the emergency department and orthopedic clinics adequately screening for possible abuse? Pediatr Emerg Care 2003; 19(3): 148-53.
24. Ozkara E, Canturk G, Canturk N, Ozata AB, Yavuz MF. Evaluation of forensic perinatal and neonatal autopsies in Istanbul. Indian J Pediatr 2009; 76(2): 167-70.