The Journal Club

Reviews and summaries of journal articles related to child abuse, maltreatment, death and safety will be featured here and updated monthly. Readers are encouraged to comment via E-Mail (see home page) on the articles featured. Selected comments will be featured the following month. The views represented in this forum are those of the Web page author and do not represent the view of the Office of Chief Medical Examiner, City of New York or any of participating agencies of the New York City Multidisciplinary Child Fatality Review unless stated otherwise.

Current Selections - November/December

Air Rifles-Lethal Weapons

Radhakrishnan J, Fernandez L, and Geissler G. (Journal of Pediatric Surgery 1996 Oct; 31: 1407-1408).

Sixteen patients were treated for air rifle injuries. Several of the injuries were serious enough to require surgery. One injury resulted in death after the BB perforated the ascending aorta. The authors cite several articles which support their position that injuries sustained by air rifles are not nearly as innocuous as the general public believes. Modern air rifles can achieve up to 685 feet per second which is well in excess of the velocity needed to penetrate either skin or bone.

This article is especially timely during the holiday season because it illustrates that the dangers of BB guns are beyond the traditionally associated ocular injury and require careful consideration before giving them to our children as "toys".

Fatal Accidental Dibucaine Poisoning in Children

Dayan PS, Litovitz TL, Crouch BI, Scalzo AJ and Klein BL.(Annals of Emergency Medicine 1996; 28: 442-445)

Three cases of death following the accidental ingestion of dibucaine, an ingredient in popular over-the-counter hemorrhoid preparations and burn ointments. Dibucaine is a very potent CNS and cardiac toxin, causing seizures and cardiac dysrhythmia.

The authors report that child resistant packaging for medications with dibucaine was required effective April 10, 1995. Although this will help reduce the possibility of accidental ingestion, the general public does not view these medications as a potentially lethal toxin. Perhaps more conspicuous warnings are necessary on these products.

Central Nervous System Depression Following Accidental Ingestion of Visine Drops

Tobias JD (Clinical Pediatrics 1996 Oct; 539-540)

This is a case study of a two year-old who ingested approximately 2-3 ml of Visine. The toddler was mostly unresponsive, responding only to deep pain and exhibited pinpoint pupils.

Again, this further illustrates the danger of seemingly innocuous pharmaceuticals.

Rib Fractures in 31 Abused Infants: Postmortem Radiologic-Histopathologic Study

Kleiman PK, Marks SC, Nimkin K, Rayder SM, Kessler, SC(Radiology 1996; 200: 807-810)

Thirty-one infants who died with inflicted injuries were radiographed then followed up with post mortem exams. Of the 165 fractures observed, 84 were rib fractures, however, only 30 rib fractures were identified on the skeletal survey. Of the 84 rib fractures, fifty fractures were healing, 23 were acute, and 5 were of indeterminate age.

Rib fractures are shown, once again to be common injuries associated with severe child abuse

Follow-Up Skeletal Surveys in Suspected Child Abuse

Kleiman PK, Nimkin K, Spevak MR, Rayder SM, Madansky DL, Shelton, YA and Patterson, MM(AJR;October 1996; 167: 893-896)

Twenty-three infants and toddlers who were strongly believed to be physically abused based on initial radiological findings were followed up with skeletal surveys approximately two weeks following the initial exam. Of the 23 children, 14 were found to have additional skeletal trauma which was not identified on the initial exam.

Fractures become easier to identify once they begin to heal. This study illustrates the importance of follow-up skeletal surveys in the succesful identification, and in some cases the dating of skeletal injury.

If anyone has had different experiences from the opinions stated or wishes to commnet on the presented articles or any child abuse or fatality related article please e-mail your comment to William Browning. If you do not wish your comments published on this Web page please indicate so in your correspondence.