EPIDEMIOLOGICAL PROFILE OF INJURIES IN PATIENTS WITH HIGH DIAGNOSTIC SUSPICION OF ABUSE

Souza, Isaias Silva Ribeiro de; Poncio, Victor Peyneau; Molina, Matheus Giovanni Medina; Perera, Georges Akira Shigekiyo; Cocco, Luiz Fernando; Dobashi, Eiffel Tsuyoshi

doi:10.1590/1413-785220253304e290194

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Original Article/Trauma • Acta Ortop Bras 33 (4) • 2025 • https://doi.org/10.1590/1413-785220253304e290194 linkcopy

EPIDEMIOLOGICAL PROFILE OF INJURIES IN PATIENTS WITH HIGH DIAGNOSTIC SUSPICION OF ABUSE

PERFIL EPIDEMIOLÓGICO DAS LESÕES EM PACIENTES COM ALTA SUSPEIÇÃO DIAGNÓSTICA DE MAUS TRATOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: This study aimed to analyze the epidemiological profile of child abuse cases treated at Hospital Geral de Pirajussara, São Paulo, and to understand the characteristics of associated injuries.

Methods: A retrospective cross-sectional study was conducted by reviewing medical records of patients suspected of abuse, aged 18 years or younger, from January 2012 to December 2022. Data on sex, age, trauma mechanism, presence of fractures, and outcomes were analyzed.

Results: A total of 58 records were included. Most cases involved adolescents (50%, n=29). The most common abuse mechanism was physical force (36.21%, n=21), followed by direct trauma by object (13.79%, n=8). Fractures were present in 41.38% of cases (n=24), with skull and facial fractures being the most frequent (33.33%, n=7). Brain injuries were the most common associated injuries (42.42%, n=14). Most cases (77.59%, n=45) were discharged with an average hospital stay of 9 days.

Conclusions: Abuse is prevalent among young children under 1 year and adolescents (13-18 years). Identified patterns of injuries and abuse mechanisms highlight the need for stringent screening and management protocols. Continuous training and vigilance are crucial for effective prevention and intervention. Level of Evidence III; Cross-Sectional Retrospective Study.

Keywords:
Child Abuse; Child Maltreatment; Epidemiology; Aggression; Fractures; Bone; Child

	N (%)
Barueri	1 (1.72)
Carapicuiba	1 (1.72)
Cotia	1 (1.72)
Embu of the Arts	21 (36.21)
Ibiuna	1 (1.72)
Itaberada	1 (1.72)
Itapecerica da Serra	1 (1.72)
Itapevi	1 (1.72)
São Paulo	6 (10.34)
Taboão da Serra	24 (41.38)

		Total	Male	Female
N (%)		58	31 (53.45)	27 (46.55)
Average age (years) (SD)		10.20 (6.55)	9.72 (6.8)	10.75 (6.33)
Min-Max		1 day - 18 years	1 day - 18 years	1 month - 18 years
Division by age group N(%)	< 1 year	12 (20.69)	7 (12.07)	5 (8.62)
	1-6 years	6 (10.34)	4 (6.9)	2 (3.44)
	7-12 years	11 (18.96)	7 (12.07)	4 (6.89)
	13-18 years	29 (50)	13 (22.41)	16 (27.59)
Cases per year N(%)	2015	18 (31.03)	14 (24.14)	4 (6.9)
	2016	12 (20.69)	4 (6.9)	8 (13.79)
	2017	7 (12.07)	4 (6.9)	3 (5.17)
	2018	7 (12.07)	4 (6.9)	3 (5.17)
	2019	4 (6.9)	1 (1.72)	3 (5.17)
	2020	4 (6.9)	1 (1.72)	3 (5.17)
	2021	4 (6.9)	2 (3.45)	2 (3.44)
	2022	2 (3.45)	1 (1.72)	1 (1.72)

					Male		Female		Internation
		N (%)	Min-max	Middle Age (SD)	N (%)	Age Mean (SD)	N (%)	Middle Age (SD)	Yes N(%)	No N(%)	Duration (days) Mean (SD)
		N (%)	Min-max	Middle Age (SD)	N (%)	Age Mean (SD)	N (%)	Middle Age (SD)	Yes N(%)	No N(%)	Duration (days) Mean (SD)
Mechanism of abuse	Abandonment of incapable	2 (3.45)	1 day - 2 months	0.09 (0.12)	2 (3.45)	0.09 (0.12)	0		2 (3.45)	0	3.5 (3.54)
	Sexual abuse	2 (3.45)	14 - 16 years	15 (1.41)	0		2 (3.45)	15 (1.41)	2 (3.45)	0	2.5 (2.12)
	Affecting	1 (1.72)	9 years	9	1 (1.72)	9	0		1 (1.72)	0	7
	Spaning	6 (10.34)	12 - 18 years	15.17 (2.32)	4 (6.9)	14.5 (2.65)	2 (3.45)	16.5 (0.71)	5 (8.62)	1 (1.72)	33.8 (39.19)
	White gun injury	4 (6.9)	13 - 18 years	15.5 (3.54)	1 (1.72)	18	3 (5.17)	16.33 (2.89)	4 (6.9)	0	5 (2.94)
	Fire gun injury	4 (6.9)	5 - 18 years	11.5 (6.95)	3 (5.17)	13.33 (7.23)	1 (1.72)	6	2 (3.45)	2 (3.45)	4 (4.24)
	Body strength	21 (36.21)	1 month - 18 years	10.51 (6.55)	10 (17.24)	9.85 (7.32)	11 (18.97)	11.10 (6.07)	15 (25.86)	6 (10.34)	4.13 (3.44)
	Human bite	1 (1.72)	15 years	15	0		1 (1.72)	15	0	1 (1.72)
	Negligence	2 (3.45)	5 months - 11 years	5.71 (7.48)	1 (1.72)	11	1 (1.72)	0.42	2 (3.45)	0	6 (0)
	Direct Trauma by Object	8 (13.79)	3 - 18 years	10.88 (5.54)	5 (8.62)	9.8 (6.83)	3 (5.17)	12.67 (2.52)	5 (8.62)	3 (5.17)	4 (3.67)
	Fall	5 (8.62)	1 month - 12 years	3.6 (5.12)	3 (5.17)	5.78 (5.87)	2 (3.45)	0.33 (0.35)	5 (8.62)	0	17.8 (19.77)
	No data	3 (5.17)	2 months - 14 years	4.78 (7.98)	1 (1.72)	0.17	2 (3.45)	7.09 (9.78)	1 (1.72)	2 (3.45)	3
Fraud	Yes*	21 (36.21)	1 month - 18 years	9.66 (7.13)	14 (24.14)	9.49 (7.48)	7 (12.07)	10.01 (6.91)	20 (34.48)	1 (1.72)	9.45 (19.54)
	No	34 (58.62)	1 day - 18 years	10.66 (6.28)	15 (25.86)	10.34 (6.28)	19 (32.76)	10.91 (6.44)	21 (36.21)	13 (22.41)	7.14 (10.50)
	No data	3 (5.17)	2 months - 13 years	8.72 (7.41)	2 (3.45)	6.59 (9.07)	1 (1.72)	13	2 (3.45)	1 (1.72)	30.5 (41.72)
*Yes	Hand	4 (19.05)	15 - 17 years	15.5 (1)	3 (14.29)	15.67 (1.15)	1 (4.76)	15	3 (5.17)	1 (1.72)	3 (1)
	Lower members	5 (23.81)	1 month - 17 years	4.85 (7.08)	4 (19.05)	5.56 (7.96)	1 (4.76)	2	5 (8.62)	0	6 (5.15)
	Superior members	5 (23.81)	1 month - 15 years	7.82 (6.59)	1 (4.76)	3	4 (19.05)	9.02 (6.94)	5 (8.62)	0	3.6 (1.67)
	Crane and face	7 (33.33)	4 months - 18 years	9.8 (8.25)	6 (28.57)	8.6 (8.34)	1 (4.76)	17	7 (12.07)	0	16.57 (32.42)
Associated injuries	Yes**	33 (56.9)	1 day - 18 years	9.49 (7.15)	16 (27.59)	8.86 (7.03)	17 (29.31)	10.08 (7.42)	27 (46.55)	6 (10.34)	7.07 (9.72)
	No	23 (39.66)	1 month - 18 years	11.53 (5.42)	13 (22.41)	11.25 (6.47)	10 (17.24)	11.9 (3.96)	15 (25.86)	8 (13.79)	9.93 (22.4)
	No data	2 (3.45)	2 months - 13 years	6.59 (9.07)	2 (3.45)	6.59 (9.07)	0		1 (1.72)	1 (1.72)	60
**Yes	Brain	14 (42.42)	1 day - 18 years	6.28 (7.33)	8 (24.24)	6.57 (7.1)	6 (18.18)	5.89 (8.3)	8 (13.79)	6 (10.34)	6 (6.26)
	Torax	5 (15.15)	2 months - 18 years	10.83 (7.99)	4 (12.12)	10.29 (9.12)	1 (3.03)	13	5 (8.62)	0	7.2 (0.84)
	Abdomen	3 (9.09)	10 - 18 years	14.33 (4.04)	2 (6.06)	14 (5.66)	1 (3.03)	15	3 (5.17)	0	6 (4.58)
	Nerves and tendons	2 (6.06)	14 - 18 years	16 (2.83)	0		2 (6.06)	16 (2.83)	2 (3.45)	0	3 (0)
Outcome	Altab	45 (77.59)	1 month - 18 years	10.64 (6.19)	22 (37.93)	9.94 (6.5)	23 (39.66)	11.31 (5.93)	36 (62.07)	9 (15.52)	9 (16.31)
	Death	6 (10.34)	1 day - 18 years	3.91 (7.17)	4 (6.9)	5.79 (8.46)	2 (3.45)	0.14 (0.04)	1 (1.72)	5 (8.62)	1
	Judicial transfer	1 (1.72)	11 years	11	1 (1.72)	11	0		1 (1.72)	0	8
	Escape	1 (1.72)	4 months	0.33	1 (1.72)	0.33	0		1 (1.72)	0	4
	Ambulatory route	1 (1.72)	18 years	18	1 (1.72)	18	0		1 (1.72)	0	1
	No data	4 (6.9)	13 - 17 years	15 (1.63)	2 (3.45)	15 (2.83)	2 (3.45)	15 (0)	3 (5.17)	1 (1.72)	20.67 (34.06)

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[TFN1] The prevalence of hospitalization and non-hospitalization was calculated compared to the general sample (N=58). The prevalence of fractures and associated lesions was calculated compared to the general sample (N=58) and the prevalence of specific fractures and associated lesions was calculated compared to the positive fractural cases sample (N=21) and associated lesions (N=33). ^aDirect trauma per object includes contundent object (aspirator); perforating-cutting object; direct trauma by skate and direct trauma by unspecified objects. ^a‘Fall’ includes falls from objects such as a plate, bed, or crib, as well as falls from different floor levels. ^bIncludes post-surgical discharge; post-procedures; post-evaluation of social service; post-evaluation of custodial council and judicial discharge after loss of custody.

[TFN2] ^*
38.1% (N=8) presented laterality to the right, 33.33% (N=7) to the left and 14.29% (N=3) did not contain data. *Hand fractures include phalanges and metacarpal. *Lower limb fractures include femur and tibia. *Upper limb fractures include humerus and forearm. *Face and skull fractures include skull, occipit, orbit, jaw, and nasal fracture.

[TFN3] ^**
Brain injuries include TCE, extradural hematoma, intracranial hypertension and cerebral death.** Thoracic lesions include pneumothorax and increased mediastinum. ** Abdominal lesions include liver, kidney, splenic and unspecified lesions.