It was a very sunny day when I interviewed my old pediatrician. He used to work in the Emergency department when he was younger before switching over to pediatrics. I approached him with questions regarding dilemmas in pediatrics when he told me about an incidence in the emergency department which was a difficult case for him during his resident year. The case history
A 21 month old boy presented to his local emergency department having reportedly fallen down the stairs. The mother said she left the stair guard open and the young boy tripped on the top of the step, falling the whole flight stairs, landing on a floor striking his head on the wall. He was brought to the hospital couple of hours after the fall, complaining of pain in his arm …show more content…
A case meeting was held and a formal case conference followed later on. Over several days the child woke and was eventually extubated successfully, at which stage a complete skeletal survey was undertaken. An MRI scan was also obtained whilst the child was anesthetized.
This case demonstrates many of the difficulties in caring for children where NAI is suspected. This child has many features found in such cases, including a history that changes with time, some delay in presentation, two cardinal features of NAI (subdural collections and retinal hemorrhages) and a family with a history of violence. Nevertheless, the history given is of a serious accident that could also cause substantial injury.
Unfortunately it is not the role of the PICU team to make an early judgment on the cause of injuries in these children, but it is crucial that the possibility of non accidental injury is considered, and that appropriate investigations (including careful examination) are undertaken and clearly documented.
The Laming report has also recently emphasized the importance of communicating with all agencies that might have additional information (primary care physician, social services,
Police, etc.) to ensure that all parties have a full picture of the concerns. Serious
A 21 month old boy presented to his local emergency department having reportedly fallen down the stairs. The mother said she left the stair guard open and the young boy tripped on the top of the step, falling the whole flight stairs, landing on a floor striking his head on the wall. He was brought to the hospital couple of hours after the fall, complaining of pain in his arm …show more content…
A case meeting was held and a formal case conference followed later on. Over several days the child woke and was eventually extubated successfully, at which stage a complete skeletal survey was undertaken. An MRI scan was also obtained whilst the child was anesthetized.
This case demonstrates many of the difficulties in caring for children where NAI is suspected. This child has many features found in such cases, including a history that changes with time, some delay in presentation, two cardinal features of NAI (subdural collections and retinal hemorrhages) and a family with a history of violence. Nevertheless, the history given is of a serious accident that could also cause substantial injury.
Unfortunately it is not the role of the PICU team to make an early judgment on the cause of injuries in these children, but it is crucial that the possibility of non accidental injury is considered, and that appropriate investigations (including careful examination) are undertaken and clearly documented.
The Laming report has also recently emphasized the importance of communicating with all agencies that might have additional information (primary care physician, social services,
Police, etc.) to ensure that all parties have a full picture of the concerns. Serious