Development of a Computer Simulation Model to Predict Potential Bruising Patterns Associated with Common Childhood Falls

As submitted by the proposer: Child abuse is a leading cause of fatality in children aged 0-4 years, with approximately 1,500 fatalities annually. Infants (younger than 1 year) are at greatest risk. Most infants and children have earlier, non-life threatening injuries prior to a fatal assault. These earlier injuries, termed sentinel injuries, are often misinterpreted as accidental trauma due to false histories provided by caregivers. The ability to detect child abuse in its earliest stages has proven to be critical in the prevention of escalating injury severity and even death. Bruising is the earliest sign of physical abuse, and previous studies have shown differences in bruising location and number when comparing accidental vs. abusive trauma. Differentiation between accident and abuse based upon bruising patterns presents an opportunity for early diagnosis/detection of abuse, as well as a means to exonerate innocent families in cases where accidental trauma has occurred. Bruising patterns provide a "roadmap" documenting a child's exposure to impact, providing information that can be critical in a forensic analysis. Currently there are limited means to predict potential bruising patterns associated with common household falls or abusive events that include the ability to investigate the influence of fall environment- and child-specific parameters. Moreover, knowledge of potential bruising patterns and corresponding injury events does not exist. In this study we will develop and use a computer simulation model of a pediatric surrogate to characterize potential bruising patterns associated with common household falls often falsely reported as the cause of injury in abuse. This will be accomplished through development and adaptation of a virtual sensing skin to a computer model of a pediatric surrogate. We will use experimental falls employing an instrumented physical surrogate capable of measuring/recording impact locations to verify our model's predictive capability. We will also investigate the influence of surrogate properties and fall environment on potential bruising patterns. The outcomes from this project will include a pediatric computer simulation model capable of predicting potential bruising patterns in bed/sofa falls, along with predicted bruising patterns. We will also gain an improved understanding of how fall victim and fall environment factors influence bruising patterns and will disseminate our findings through peer-reviewed journals, trade magazines and conference presentations to an audience of judicial practitioners and clinicians. Working with Lurie Children's Hospital, our project will be completed over a two-year period. ca/ncf