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Cutaneous Findings Mistaken for Physical Abuse: Present but Not Pervasive

Authors

  • Kimberly A. Schwartz M.D.,

    Corresponding author
    1. Boston Medical Center, Pediatrics, Child Protection Team, Boston, Massachusetts
    • Address correspondence to Kimberly A. Schwartz, M.D., Boston Medical Center, Pediatrics, Child Protection Team, 850 Harrison Avenue, 5th Floor, Boston, MA 02118, or e-mail: KSchwartzMD.cap@gmail.com.

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  • James Metz M.D.,

    1. Seattle Children's Hospital, Seattle, Washington
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  • Kenneth Feldman M.D.,

    1. General Pediatrics, Department of Dermatology, School of Medicine, Seattle Children's Hospital and University of Washington, Seattle, Washington
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  • Robert Sidbury M.D., M.P.H.,

    1. General Pediatrics, Department of Dermatology, School of Medicine, Seattle Children's Hospital and University of Washington, Seattle, Washington
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  • Daniel M. Lindberg M.D.,

    1. Department of Emergency Medicine, University of Colorado, Denver, Colorado
    2. Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Denver, Colorado
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  • and for the ExSTRA Investigators


Abstract

Incorrect diagnoses during child abuse evaluations are serious. Because skin lesions are common in abuse, it is important to consider cutaneous mimics of physical abuse. The current study prospectively identified cutaneous mimics in a cohort of children evaluated for possible physical abuse. This is a secondary analysis of data from the Examining Siblings To Recognize Abuse research network's prospective, observational, cross-sectional study involving 20 U.S. child abuse teams. Subjects were younger than 10 years old and were evaluated by child abuse physicians (CAPs) for concerns of physical abuse. CAPs prospectively documented whether mimics were identified during their physical abuse evaluations. Details of each patient with cutaneous mimics were evaluated to determine the types of mimics, which part of the evaluations identified mimics, and the perceived abuse likelihood. Of 2,890 children evaluated for physical abuse, 137 had at least one mimic identified and 69 had some cutaneous mimic components. Although 985 of 2,753 (39%) subjects without mimics had high levels of abuse concern, only 9 of 137 (6%) children with mimics had high levels of abuse concern (p < 0.001). Of 69 children with cutaneous mimics, 56 (81%) were diagnosed by history and physical examination. Cutaneous abuse mimics were identified in 2.4% of children evaluated for physical abuse. Although it was eventually determined that there was little or no concern for abuse in 84% of children with cutaneous mimics, a small number were physically abused. CAP evaluation may be valuable in recognizing children with cutaneous mimics who also were abused.

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