Harper co-authors article that can help in detection of child abuse

Nancy Harper, MD
Nancy Harper, MD, medical director of the Child Abuse Resource and Evaluation (CARE) Team

CORPUS CHRISTI – Nancy Harper, MD, medical director of the Child Abuse Resource and Evaluation (CARE) Team at Driscoll Children’s Hospital, co-authored an article in the January 2013 issue of the journal Pediatric Emergency Care that could ultimately help save the lives of abused children. Through an analysis of data collected from examinations of more than 2,000 children, Dr. Harper and her co-authors established that certain X-rays of the hands, feet, spine and pelvis can reveal otherwise hidden abusive injuries and, in turn, lead to the prevention of future injuries. It had been suggested previously that some views of the hands, feet, spine and pelvis should be omitted from routine skeletal examinations, called skeletal surveys, because fractures are rarely found.

“We determined that if special views of these areas had been omitted, a significant number of occult, or hidden, abusive fractures would have been missed,” Dr. Harper said. “Missing abusive injuries may place a child at risk for further abusive injury and death.”

The article by Dr. Harper and her colleagues, titled “Prevalence of Abusive Fractures of the Hands, Feet, Spine, or Pelvis on Skeletal Survey: Perhaps ‘Uncommon’ Is More Common Than Suggested,” can be found at www.pec-online.com. The group’s conclusions came after they analyzed data collected from the Examining Siblings To Recognize Abuse (ExSTRA) research network. The data, based on skeletal surveys from 2,049 children, showed that 23 percent of them had at least one previously unknown fracture in the initial skeletal survey. When fractures are found, the survey is referred to as a positive skeletal survey. Of the children with positive skeletal surveys, 10.4 percent had a fracture to the hands, feet, spine or pelvis.

The surveyed children came from a group of nearly 3,000 who were part of a study by the ExSTRA network between January 2010 and April 2011, Dr. Harper said. They were evaluated by 20 child abuse teams in the United States, including the CARE Team at Driscoll Children’s Hospital. Dr. Harper served as the principle center investigator at Driscoll and Sonja Eddleman, RN, CFN was the center coordinator.

Dr. Harper hopes her research provides guidance to physicians and radiologists in evaluating children for suspected child abuse.

“The detection of occult, or hidden, abusive fractures will likely prevent additional serious or fatal inflicted injury in children,” she said.

Dr. Harper co-authored another article on the subject that will be published Feb. 11 on the web site of Pediatrics, the official journal of the American Academy of Pediatrics (http://pediatrics.aappublications.org/).