What Do Confessions Reveal About Abusive Head Trauma? A Systematic Review.

Although confessions related to abusive head trauma (AHT) are reported, no detailed analysis exists. Therefore, we systematically reviewed studies of AHT confessions and examined the details, including country of origin, mechanisms and perpetrators' characteristics [PUBLISHER - THE PRECEDING UNDERLINED TEXT IS FOR THE MARGIN]. Employing 36 search terms across three search engines, we searched Medline and CINAHL from 1963 to 2018. All relevant studies underwent two independent reviews and data extraction. Descriptive statistics were used to characterise the sample; chi square and Fisher's exact tests were used to assess differences in demographic and clinical characteristics. Of 6759 identified studies, 157 full texts were reviewed and 55 articles from 15 countries spanning four continents were included. Included articles contained 434 confessions. The mechanisms of abuse included shaking alone (64.1%), impact alone (17.1%), shaking plus impact (18.0%) and other (0.9%). There was no statistically significant difference in the percentage of confessions reporting shaking alone when comparing continents: North America (64.0%), Europe (64.2%) and Oceania (60.0%; P=.92), or when comparing circumstances in which the confession was obtained: medical evaluation (74.6%) vs police or judicial investigations (63.4%; P=.11). Of 119 cases with identified perpetrators, 67.2 per cent were cases with males alone. Confessions reveal striking similarities in the mechanism of AHT (predominantly shaking) and occur across the globe.

Suicidality among preadolescent maltreated children in foster care.

This study sought to determine the prevalence of suicidal ideation, plans, and attempts among 515 preadolescent (aged 9-11 years) maltreated children who entered foster care within the prior year. Over a quarter (26.4%) of the children had a history of suicidality according to their own and/or their caregiver's report, 4.1% of whom were imminently suicidal. In bivariate analyses, children at higher risk of suicidality tended to be younger, non-Hispanic, abused, and to have experienced multiple types of maltreatment, more referrals to child welfare, more household transitions, and a longer length of time in foster care. There were no gender differences. Multiple regression analyses found physical abuse and chronicity of maltreatment to be the most robust predictors of suicidality. It is critically important that these high-risk children are screened for suicidality before adolescence and that caregivers and professionals are informed of their risk status so that they may implement mental health treatment, monitoring, and harm reduction measures.

Characteristics of child dental neglect: a systematic review.

OBJECTIVE: Neglect of a child's oral health can lead to pain, poor growth and impaired quality of life. In populations where there is a high prevalence of dental caries, the determination of which children are experiencing dental neglect is challenging. This systematic review aims to identify the features of oral neglect in children. METHODS: Fifteen databases spanning 1947-2012 were searched; these were supplemented by hand searching of 4 specialist journals, 5 websites and references of full texts. Included: studies of children 0-18 years with confirmed oral neglect undergoing a standardised dental examination; excluded: physical/sexual abuse. All relevant studies underwent two independent reviews (+/- 3rd review) using standardised critical appraisal. RESULTS: Of 3863 potential studies screened, 83 studies were reviewed and 9 included (representing 1595 children). Features included: failure or delay in seeking dental treatment; failure to comply with/complete treatment; failure to provide basic oral care; co-existent adverse impact on the child e.g. pain and swelling. Two studies developed and implemented 'dental neglect' screening tools with success. The importance of Quality of Life tools to identify impact of neglected dental care are also highlighted. CONCLUSIONS: A small body of literature addresses this topic, using varying definitions of neglect, and standards of oral examination. While failure/delay in seeking care with adverse dental consequences were highlighted, differentiating dental caries from dental neglect is difficult, and there is a paucity of data on precise clinical features to aid in this distinction. CLINICAL SIGNIFICANCE: Diagnosing dental neglect can be challenging, influencing a reluctance to report cases. Published evidence does exist to support these referrals when conditions as above are described, although further quality case control studies defining distinguishing patterns of dental caries would be welcome.

Do chest compressions during simulated infant CPR comply with international recommendations?

BACKGROUND: Morbidity and mortality remain high following infant cardiac arrest. Optimal cardiopulmonary resuscitation (CPR) is therefore imperative. OBJECTIVE: Comparison of two-thumb (TT) and two-finger (TF) infant chest compression technique compliance with international recommendations. DESIGN: Randomised cross-over experimental study. METHODS: Twenty-two certified Advanced Paediatric Life Support (APLS) instructors performed 2 min continuous TT and TF chest compressions on an instrumented infant CPR manikin. Compression depth (CD), release force (RF), compression rate (CR) and duty cycles (DCs) were recorded. Quality indices were developed to calculate the proportion of compressions that complied with internationally recommended targets, and an overall quality index was used to calculate the proportion that complied with all four targets. RESULTS: Mean CD was 33 mm and 26 mm (p<0.001; target ≥36.7 mm), mean RF was 0.8 kg and 0.2 kg (p<0.001; target <2.5 kg), mean CR was 128/min and 131/min (p=0.052; target 100-120/min) and mean DCs was 61% and 53% (p<0.001; target 30-50%) for the TT and TF techniques, respectively. With the exception of RF, the majority of compressions failed to comply with targets. The TT technique improved median CD compliance (6% vs 0% (p<0.001)), while the TF technique improved median DC compliance (23% vs 0% (p<0.001)). Overall compliance with all four targets was <1% for both techniques (p=0.14). CONCLUSIONS: Compliance of APLS instructors with current international recommendations during simulated infant CPR is poor. The TT technique provided improved CD compliance, while the TF technique provided superior DC compliance. If this reflects current clinical practice, optimisation of performance to achieve international recommendations during infant CPR is called for.

Does a more "physiological" infant manikin design effect chest compression quality and create a potential for thoracic over-compression during simulated infant CPR?

Poor survivability following infant cardiac arrest has been attributed to poor quality chest compressions. Current infant CPR manikins, used to teach and revise chest compression technique, appear to limit maximum compression depths (CDmax) to 40 mm. This study evaluates the effect of a more "physiological" CDmax on chest compression quality and assesses whether proposed injury risk thresholds are exceeded by thoracic over-compression. A commercially available infant CPR manikin was instrumented to record chest compressions and modified to enable compression depths of 40 mm (original; CDmax40) and 56 mm (the internal thoracic depth of a three-month-old male infant; CDmax56). Forty certified European Paediatric Life Support instructors performed two-thumb (TT) and two-finger (TF) chest compressions at both CDmax settings in a randomised crossover sequence. Chest compression performance was compared to recommended targets and compression depths were compared to a proposed thoracic over-compression threshold. Compressions achieved greater depths across both techniques using the CDmax56, with 44% of TT and 34% of TF chest compressions achieving the recommended targets. Compressions achieved depths that exceeded the proposed intra-thoracic injury threshold. The modified manikin (CDmax56) improved duty cycle compliance; however, the chest compression rate was consistently too high. Overall, the quality of chest compressions remained poor in comparison with internationally recommended guidelines. This data indicates that the use of a modified manikin (CDmax56) as a training aid may encourage resuscitators to habitually perform deeper chest compressions, whilst avoiding thoracic over-compression and thereby improving current CPR quality. Future work will evaluate resuscitator performance within a more realistic, simulated CPR environment.