Suspicious Injury Report California: Fill & Download for Free

Q. What is something that is painful to see?A. Imagine you are a radiologist reading films from the Emergency Department of young children suffering from minor trauma and you see these xrays of the chest, skeleton, CT scan images of the brain and of the abdomen and MRI of the brain.RibsFemursKneeCT Brain (blood is white)CT Brain (2nd patient, died)CT SkullMRI Brain - white new blood, grey old bloodCT Abdomen (arrow to liver)CT Abdomen (arrow to pancreas)You go examine the patients.4 million children abused, 2,000 deaths/year.Shaken infant syndrome classic pattern of injuries. Child held around the chest and violently shaken back and forth, causing the extremities and the head to flail back and forth in a whiplash movement.Intracranial injury occurs as a result of severe angular acceleration, deceleration and direct impact as the head strikes a solid object.The chest is compressed resulting in rib fractures.Arms and legs move about in a whiplash movement resulting in the typical 'corner' or 'bucket-handle'-fractures in the metaphyseal region. 10% under age 5 brought to ER with alleged accidents actually abused. Wide range of findings can mimic other disease. Further injury if delayed in diagnosis.Radiologist can suggest diagnosis when studies are performed for other reasons. High degree of suspicion, inability to explain the degree of injury or a reported mechanism of injury that is inconsistent with the physical findings.Skeletal InjuryForces needed to break a bone in an infant or young child are enormous.Any fracture in this age group indicates a major traumatic event, not just a fall from a low height.Fractures with a high specificity for child abuse:Metaphyseal corner or bucket handle fracture.Rib fractures children less than 2 year.Fractures of the acromion, sternum and spinous processes.Occipital impression and other skull fractures occur when the head strikes a solid object.Corner fractureSmall piece of bone is avulsed due to shearing forces on the fragile growth plate. Can be subtle, hence skeletal surveys for suspected infant abuse must be good quality.Bucket handle fracturesEssentially same as corner fractures, but avulsed bone fragment is larger and seen 'en face' as a disc or bucket handle. Most common in the tibia, distal femora and proximal humeri. Frequently bilateral.Rib fracturesIn violent shaking, the child is held very tightly around the chest and squeezed while being shaken. This compresses the ribs front to back and tends to break them next to their attachment to vertebrae, and laterally where they are being literally almost folded in half. Therefore, lateral and posterior rib fractures are highly specific for abuse. CPR does not cause such fractures.(Found incidentally on chest X-rays for other reasons such as pneumonia.)Bone Scan: Each hot spot in the skeleton is a fracture (besides growth plates)Skull fracturesSkull fractures are common child abuse injuries, but they are also common in accidental trauma.Patterns of skull fracture that suggest child abuse are:- Multiple 'eggshell' fractures- Occipital impression fractures- Fractures crossing suturesThe infant's skull is very resistant to trauma, so any fracture that is inconsistent with the history should raise the question of non-accidental injury.LEFT: eggshell fractures in a child who died of cerebral injury after being thrown of a height. RIGHT: skull fracture crossing suture in abused childDiaphyseal fracturesDiaphyseal (long bone) fractures are non-specific as they do occur in both accidental and non-accidental injury. However, in these cases the age of the child and the history become very important. A fall out of a bed will usually not produce a diaphyseal fracture. In order to break a femur you have to fold it with enormous power. Spiral fractures are a result of twisting forces which are uncommon in accidents in young children, but more common in adults. So a simple fall does not produce a spiral fracture in a child.Two infants with a femur fracture. Child abuse was suspected because of the age of the child and an inconsistent history given by the parents.Fracture healingCallus in long bone fractures generally forms no earlier than 5 days after a fracture, but will usually form by 14 days. A child that fell out of bed the day before cannot have a fracture with callus formation.Diaphyseal femur fracture with a lot of callus is at least 2 weeks old.CNS (Central Nervous System) InjuryCNS injury related to nonaccidental injury is a leading cause of morbidity and mortality in infants and children. 80% deaths under age 2. A baby's neck muscles are very weak and its head is large and heavy in proportion to the rest of its body. When a baby is shaken, the neck snaps back and forth, like whiplash injury, causing the brain to hit the front and back of the skull. This can damage the brain and cause it to bruise, bleed and swell.CT Brain: Subdural hematomas arise from disruption of delicate bridging veins extending from the cortex to the dural sinuses. Blood to extend into the posterior interhemispheric fissure.Child died of CNS injuries. Further examination also revealed rib fractures. CT: hematoma in the interhemispheric region.MR Brain: more sensitive in detecting subdural hematomas.T1WI shows bilateral fluid collections as a result of chronic bilateral subdural hematomas and new subdural hematomas in the right frontal and posterior interhemispheric region.Other injuriesVisceral injuryVisceral injury is seen at autopsy of young infants, 2-10% of all abdominal injury results from child abuse. Mean age of 2 years, more common in boys, mortality rate is 50% due to 'patients and doctors delay'. These children are brought to the hospital days after the injury, when a perforation already has resulted in peritonitis and sepsis.The history given by the abusers usually does not correlate with the symptoms, which makes these cases very difficult to evaluate for the clinician.Common abdominal injuries in abused children are liver laceration, duodenal hematoma and pancreatic laceration.The most common non-accidental abdominal injuries are:- visceral perforation or hematoma- liver- and pancreatic laceration- adrenal bleedingSurprisingly the most common abdominal accidental injuries, which are laceration or subcapsular bleeding of the spleen and the kidney, are unusual in these children.Pancreatic laceration in child abuseLiver laceration in child abuse. These abdominal injuries are non specific and could also be attributed to accidental injury. History does not correlate well with the injuries.Liver laceration in child abuseImaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children (clinicalradiologyonline.net)Foster Son Starves While Mom And Daughter Eat, Then A Customer Interrupts And Does Something Amazing | SmartiedRadiological Imaging in Infant Non-Accidental InjuryIn the UK, seven percent of children will have experienced serious physical abuse from their primary carers at some point during their childhood. Appropriate and effective imaging techniques can drastically improve diagnosis of resultant non-accidental injury (NAI) from child abuse. This includes suitable imaging modality choice and techniques set out by expert opinion and clinical guidelines, such as the standards for radiological investigations of suspected non-accidental injury produced by the Royal College of Radiologists (RCR) in collaboration with the Royal College of Paediatrics and Child Health (RCPCH). There are certain markers that are almost diagnostic of NAI, for example classic metaphyseal lesions or subdural and retinal haemorrhage with encephalopathy. Effective evaluation of these findings by a capable radiologist will lead to accurate and efficient diagnosis and management. Furthermore, an awareness of potential radiological mimics of NAI is vital for appropriate diagnosis. If this is achieved successfully, radiologists and other members of the multidisciplinary healthcare team can have a direct, positive impact on effective management of these sensitive cases.Abusive head trauma - WikipediaNever EVER Shake a Baby - A NYT Article Every New Parent Should ReadShaken Baby Syndrome: A Diagnosis That Divides the Medical WorldPerhaps no crime staggers the mind, or turns the stomach, more than the murder of a baby, and so it is not a surprise when law enforcement comes down hard on the presumed killers. Often enough, these are men and women accused of having succumbed to sudden rage or simmering frustration and literally shaken the life out of a helpless infant who would not stop crying or would not fall asleep.Shaken baby syndrome has been a recognized diagnosis for several decades, though many medical professionals now prefer the term abusive head trauma. It is defined by a constellation of symptoms known as the triad: brain swelling, bleeding on the surface of the brain and bleeding behind the eyes. For years, those three symptoms by themselves were uniformly accepted as evidence that a crime had been committed, even in the absence of bruises, broken bones or other signs of abuse. While many doctors, maybe most, still swear by the diagnosis, a growing number have lost faith. Not that they doubt that some babies have been abused. But these skeptics assert that factors other than shaking, and having nothing to do with criminal behavior, may sometimes explain the triad.Has the syndrome been diagnosed too liberally? Are some innocent parents and other caretakers being wrongly sent to prison? Those questions, at the complex intersection of medicine and the law, can stir strong emotions among doctors, parents and prosecutors. They shape this first installment in a new series of Retro Report, video documentaries that explore major news stories of the past and their enduring consequences.The video’s starting point is a Massachusetts criminal case that introduced the concept of shaken baby syndrome to many Americans: the 1997 murder trial of Louise Woodward, an 18-year-old British au pair accused of having shaken an 8-month-old boy, Matthew Eappen, so aggressively that he died. Matthew also had injuries that may have predated Ms. Woodward’s joining the Eappen family in Newton, outside Boston. The focus, however, was on the triad of symptoms. To prosecution witnesses, they proved that the baby had been shaken violently, his head hitting some hard surface.The Anatomy of a Murder CaseThe anatomy of a shaken baby case from the perspective of defense attorney Adele Bernhard. Published On Sept. 13, 2015Throughout, Ms. Woodward insisted on her innocence. But a jury in state court found her guilty of second-degree murder, and she was sentenced to a prison term of 15 years to life. Within days, though, the trial judge called the murder conviction an injustice. He knocked down the charge to involuntary manslaughter, reducing the young woman’s sentence to time already served, 279 days. Many in Massachusetts and beyond were outraged. Nonetheless, Ms. Woodward was free to return to England.The “nanny murder trial,” as headline writers called it, had an unfortunate subplot. In some quarters of public opinion, Matthew’s mother, Deborah Eappen, stood figuratively in the dock as well. A doctor — like her husband, Sunil Eappen — she found herself under the sort of attack many working women face to this day. The case, a New York Times article said in 1997, “put a spotlight on the backlash against working mothers who consign their children to the care of others.”But the dominant issue was child abuse. Shaken baby syndrome is but one aspect of this phenomenon. It is a topic in which statistics can be elusive because reported episodes may not reflect the full extent of the problem. That said, a report issued in April by a division of the Department of Health and Human Services estimated that in 2013, more than 1,500 children in the United States, or four a day, died from various forms of abuse or neglect. Nearly three-fourths of the victims were under the age of 3. (Various studies over the years have suggested that a serious threat to a small child’s well-being is the presence of the mother’s live-in boyfriend.)In the Woodward trial, a key prosecution witness was Dr. Patrick Barnes, a neuroradiologist then at Children’s Hospital in Boston, now at Stanford University. “I was adamant that it had to be child abuse, shaken baby syndrome,” Dr. Barnes told Retro Report.But after the trial, he rethought his testimony and in effect became a penitent. He is now convinced that the diagnosis has been invoked too readily in criminal cases and that other causes might explain any bleeding and brain swelling. They include infections, earlier injuries from accidental falls and even strokes that occurred in utero. Other doctors who share his outlook question whether just shaking an infant, without resorting to other forms of violence, could in fact produce the triad’s telltale signs. Testing that thesis, though, may verge on the impossible: Who in the name of responsible science is about to shake a roomful of babies to see what happens?Discovering Shaken Baby SyndromeWithout question, Dr. Barnes said, abuse exists, “and we have to do our duty to protect children.” But families need protection, too, he said, and in some criminal cases, “there is no doubt that errors have been made and injustices have resulted.” Were he able to testify again in the Woodward trial, he said, he would say that the medical findings do not confirm abuse and that the baby’s injuries “could have been accidental.”One of the more exhaustive studies of shaken baby syndrome’s legal ramifications was conducted by The Washington Post and journalists from the Medill Justice Project at Northwestern University. In March, they published their analysis of about 1,800 abuse cases across the country that had reached resolution since 2001. Far more often than not — 1,600 cases — the result was a conviction. But the researchers found that in 200 cases, a substantial number, charges were dropped or dismissed, defendants were acquitted or convictions were overturned. The Retro Report video examines one such instance, involving Quentin Stone, a California man whom a jury last year cleared of charges that he had violently shaken his 3-month-old son to death.Not that the medical establishment is starting to line up on Dr. Barnes’s side. Far from it. Dr. Robert W. Block, a former president of the American Academy of Pediatrics, stands firmly by the diagnosis, telling Retro Report that abusive head trauma is supported by decades of observation.The divisions within the medical world run so deep that they pain a towering figure on this issue: Dr. A. Norman Guthkelch, a British doctor who in 1971 found a connection between baby-shaking and brain injury. “There are cases where people on both sides, both of whom I admire equally, are barely able to speak to one another, and that’s a shame,” Dr. Guthkelch, who turned 100 this month, told NPR in 2011. Yet he, too, has come to believe that the syndrome is applied too loosely in some criminal cases.As the debate continues, Louise Woodward has carved out a new life in Shropshire, in central England, where she teaches dance. Married, she has a baby of her own now, a girl born 20 months ago. Even before her pregnancy, she was quoted as telling The Daily Mail: “I know there are some people waiting for me to have a baby so they can say nasty things. It upsets me, but that is not going to stop me leading my life. I am innocent. I have done nothing wrong.”The videos with this article are part of a documentary series presented by The New York Times.A look back: Notorious au pair convicted in baby's death (Wcbv.com)Physical Abuse of Children | NEJMChild Abuse and Neglect (clinicalgate.com)Stephen LudwigPhysical AbusePhysical abuse is defined as nonaccidental physical injury to a child by parental acts or omissions. There has been an alarming increase in reported cases of child abuse throughout the United States in the past 3 decades. In all states, health professionals are now legally required to report their suspicions of abuse to their state’s child protection services (CPS) or police.Clinical PresentationDetermination of suspected abuse is based on compilation of information from five data sources: (1) history, (2) physical examination, (3) laboratory and radiographic information, (4) observation of parental–child interaction, and (5) a detailed family social history.When examining any child with an injury, the clinician should be suspicious of abuse if the history reveals an unusual delay in seeking medical care, the parents’ explanation of the injury is not compatible with the physical findings, the cause of the injury is unknown or “magical,” or there is a history of similar or repeated episodes. Parents may be reluctant to give information or their reaction may be inappropriate to the seriousness of the injuries. Other worrisome signs are a lack of primary care (no immunizations, no source of health care), a history of parental mental illness or substance abuse, and high levels of family stress.While examining the child, maintain a high index of suspicion for abuse or neglect if the child’s weight is below the third percentile for age and there is poor personal hygiene, lack of adequate clothing, behavioral disturbance (especially undue compliance with the examiner), or an abnormal interaction between the parent and child (unwarranted roughness or extreme aloofness). But realize that abuse may occur by parents of any socioeconomic or educational level.Remove all of the child’s clothing and examine the skin carefully for contusions, abrasions, burns, and lacerations in various stages of resolution. Any bruise on a child who is not yet cruising or walking is unusual. Certain skin lesions are typical for specific types of abuse; such as circular cigarette burns; human bite marks; J-shaped curvilinear or loop-shaped marks from a wire, cord, or belt; circumferential rope burns; “grid” marks from an electric heater; and symmetrical scald burns on the buttocks or extremities (Figure 12-1). Other dermatologic manifestations include cutaneous signs of malnutrition (decreased subcutaneous fat, increased creases), scalp hematomas, signs of trauma to the genital area, and signs of injuries at different stages of healing (Figure 12-2).Figure 12-1 Child abuse injury patterns.Figure 12-2 Signs of neglect and staging of injuries.Fractures are suggested by refusal to bear weight or move an extremity, gross deformity, or soft tissue swelling and point tenderness over an extremity. However, most metaphyseal chip fractures are not associated with deformity (Figure 12-3). Neurologic manifestations may include retinal hemorrhages, unexplainable irritability, coma, or convulsions (see Figure 12-3). Finally, an acute abdomen, poisoning, or any traumatic injury that cannot be explained may in fact represent forms of child abuse.Figure 12-3 Fractures and head injuries in child abuse.The differential diagnosis of the abused child includes conditions with skeletal involvement: accidental trauma, osteogenesis imperfecta, Caffey’s disease, scurvy, rickets, birth trauma, and congenital infection. Diseases with dermatologic manifestations include bleeding disorders (idiopathic thrombocytopenic purpura, leukemia, hemophilia, von Willebrand’s disease), recurrent pyodermas, and scalded skin syndrome. Sudden infant death syndrome and accidental poisonings may be mistaken for child abuse. The most common clinical problem is the differentiation between accidental and nonaccidental trauma.Evaluation and ManagementIf there is any fracture or other suggestion of any form of abuse in a child younger than 2 years of age, obtain a complete skeletal survey for trauma. For older patients, if the physical examination suggests a fracture, obtain specific radiographs. Order other radiologic studies, such as a head computed tomography or magnetic resonance imaging scan, as indicated by the nature of the injuries. Ophthalmologic consultation may be needed to identify retinal hemorrhage.In 1997, a young British nanny charged with murder brought shaken baby syndrome into the national spotlight, and raised a scientific debate that continues to shape child abuse cases today. Published On Sept. 13, 2015If the parents deny any knowledge of the cause of skin bruises, obtain a complete blood count with differential, platelet count, prothrombin time, partial thromboplastin time, and a bleeding time. The differential diagnosis and other possible laboratory studies are shown in Table 12-1.NOW YOU ARE READY TO BECOME AN EMERGENCY DEPARTMENT RADIOLOGIST.

This answer may contain sensitive images. Click on an image to unblur it.The Murder of Tupac ShakurOn the night of September 7, 1996, Tupac Shakur left a Mike Tyson fight at the MGM Grand in Los Angeles, California. He had gotten into a gang-related brawl in the MGM lobby with a man named Orlando Anderson, with the fight being broken up by hotel staff. Shakur and his record label manager Suge Knight decided to drive to a club for the night.At 11:15 PM, Tupac’s car was stopped at a red light. A white Cadillac pulled up next to him, rolled down the window, and sent rapid gunshots at Tupac. He was hit by four bullets, causing fatal injuries to his lung and chest area. The car drove away and was never found. He was rushed to the hospital, put into a medically induced coma, and died six days later on September 13.On the surface, this death seems pretty clear-cut. Tupac was murdered in cold blood in a drive-by shooting. The complications arise when we try to figure out who was behind the hit. Over two decades after the murder, it still remains an unsolved case.The police failed on numerous counts with chances they had to solve the case. They did not follow up on a report about a white Cadillac leaving the crime scene. They did not question Tupac’s friend and witness to the crime, who was also killed two months later. They did not seem to be treating this major murder of a celebrity with any of the significance or diligence it should have had.As a result of the police’s numerous failures, private citizens have had to take matters into their own hands.Some have said that Orlando Anderson, the enemy gang member who had a rivalry with Tupac and had been roughed up in the brawl earlier that night, was behind the shooting. He was the one in the car. However, Anderson was never charged and only briefly questioned regarding the murder. He died two years later in an unrelated gang shootout.Others allege that Biggie Smalls ordered the hit on Tupac because of an ongoing rap rivalry between the East and West Coast rap scenes. Still others claim that Suge Knight, the CEO of Tupac’s record label and the man sitting next to Tupac in the car, was the one who ordered the hit because Tupac was planning to leave his record label and he wanted to be able to make money off of his death.Suge Knight, the CEO of Death Row Records, Tupac’s record labelNone of these theories or investigations have managed to produce enough evidence to get the police interested in reopening investigations, however, and twenty-three years after the murder, it looks unlikely that a definitive answer will ever be found.

Theodore Jon "Ted" Kaczynski, also known as "Unabomber", is an American terrorist, mathematician, anarchist, neo-ludist and critical society. Changes In 1978 and 1995, Kaczynski ran a bomb campaign against modern technology, when three were killed by letter bombs, and he worked on July 23.… Ted Kaczynski …... Kaczynski was born in Chicago, where, as a child prodigy, he stood out from an early age. He was admitted to Harvard University at the age of 16, where he graduated, and received his doctorate in mathematics from the University of Michigan. He became an assistant professor at the University of California at Berkeley at the age of 25, but resigned two years later.From 1978 to 1995, Kaczynski sent 16 bombs targeting universities and airlines, killing three and injuring 23. Kaczynski sent a letter to the New York Times on April 24, 1995, promising "to give up terrorism" if the Times or the Washington Post published his manifesto, the Industrial Society and its future, in which he claimed that his bombings were extreme but necessary. attention is drawn to the collapse of human freedoms due to the need for modern technologies that need a large organization.Kaczynski was the target of one of the FBI's most expensive investigations. Before his identity was known, the FBI used the name UNABOMB (University and Avio BOMBash) to refer to his case, which resulted in the media calling him Unabomber. The FBI advocated the publication of Ted Kaczynski's "Manifesto," after which his brother-in-law called, followed by her husband, Ted's brother, who recognized his beliefs and writing style and reported it to the police .… Theodore Kaczynski …Kaczynski tried, unsuccessfully, to dismiss his court-elected lawyers because they wanted his insanity to be proven to avoid the death penalty because he did not believe he was insane. He was sentenced to life imprisonment without the possibility of pardon.Kaczynski's first mail bomb was directed at Buckley Crist, a professor of materials engineering at Northwestern University. On May 25, 1978, a package bearing Crist's return address was found in a parking lot at the University of Illinois at Chicago. The package was "returned" to Crist, who was suspicious because he had not sent it, so he contacted campus police. Officer Terry Marker opened the package, which exploded and caused minor injuries ... Kaczynski had returned to Illinois for the May 1978 bombing and stayed there for a time to work with his father and brother at a foam rubber factory. In August 1978, his brother fired him for writing insulting limericks about a female supervisor Ted had courted briefly. The supervisor later recalled Kaczynski as intelligent and quiet, but remembered little of their acquaintanceship and firmly denied they had had any romantic relationship. Kaczynski's second bomb was sent nearly one year after the first one, again to Northwestern University. The bomb, concealed inside a cigar box and left on a table, caused minor injuries to graduate student John Harris when he opened it ...Kaczynski has been portrayed in and inspired multiple artistic works in the realm of popular culture ... These include the 1996 television film Unabomber: The True Story, the 2011 play P.O. Box Unabomber, and Manhunt: Unabomber, the 2017 season of the television series Manhunt. The moniker "Unabomber" was also applied to the Italian Unabomber, a terrorist who conducted attacks similar to Kaczynski's in Italy from 1994 to 2006. Prior to the 1996 United States presidential election, a campaign called "Unabomber for President" was launched with the goal of electing Kaczynski as president through write-in votes.