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NON ACCIDENTAL INJURY (NAI)

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Presentation on theme: "NON ACCIDENTAL INJURY (NAI)"— Presentation transcript:

1 NON ACCIDENTAL INJURY (NAI)
M Anto ED Prov Fellow MVH 10 Nov 2016

2 Why is NAI important? Immediate: physical injuries.
Longterm: MH issues. Missed unless thought about. Classification (NSW): Neglect Physical Sexual Emotional Exposure to DV

3 Risk factors?

4 Risk factors Low SES Unemployed Single parent Substance abuse
1st child Prem Unplanned Stepchildren Disability Hx of parental abuse Birth parents more likely to abuse!

5 Questions!!! What are concerning features on history or examination (excluding injuries) would make you suspicious of NAI? What injuries are suspicious for NAI?

6 History Details Delay PHx of same

7 Examination Caregiver Child Interaction Neglect

8 Injuries

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18 Injuries [non-ortho] Bruises Pattern, circumferential, location, mum
Burns Demarcated, branding ICH Abdo Eyes/retina

19 Injuries [ortho] *Metaphyseal # (bucket handle #) – ‘pathognomonic’
*Posterior rib # *Scapula # *Spinous process # Skull # Non parietal, multiple, depressed Sternal # Multiple, different ages

20 DD Accidental Skeletal dysplasias Uncommon
Schmid-type metaphyseal chondrodysplasia, osteogenesis imperfecta I/IV Features to differentiate osteogenesis imperfecta from NAI include presence of osteopenia bowing/remodelling of bones presence of wormian bones Growth e.g. hip, base 5MT, elbow, acromion Birth injuries Rickets Congenital syphillis

21 Investigations Bloods Directed plain film Directed CT Skeletal survey
Babygrams? Bone scan Clinical photography Retinal imaging

22 Resources Mandatory reporter guide
SCAN (suspected child abuse and neglect) documentation Child protection helpline NSW health child wellbeing unit Tertiary children’s hospital – e.g. HI Family referral services Child protection training

23 What do you tell the family?

24 References RCH: Child abuse NSW health guidelines Radiopedia
The Bone School: Child abuse, NAI Diagnostic imaging pathways WA

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