Abuse is the leading cause of trauma-related fatalities in children younger than four years old.[1] However, recognizing physical abuse in pediatric patients can be difficult. Young children sustain injuries, including bruises and broken bones, during normal age-appropriate activities such as learning to walk or riding a bicycle. Differentiating expected accidental injuries from nonaccidental injuries (i.e., child abuse) is challenging for the medical and medicolegal communities.
The National Institute of Justice (NIJ) has funded academic institutions and medical examiners’ offices to research the determination of intentional versus accidental trauma in infants and children. These studies have focused on modeling skull fractures, applying biomechanical engineering techniques to determine fracture potential, identifying bruising patterns, and using advanced imaging technologies to capture minute injuries from suspected head trauma.
Skull Fractures
Accidental skull fractures are common in young children and tend to be easily treated in emergency departments.[2] However, skull fractures resulting from nonaccidental injury are often life-threatening. Differentiating between accidental and nonaccidental skull fractures is critical to accurately recognize victims of abuse.
NIJ has supported several research projects on identifying skull fracture patterns associated with nonaccidental injury. NIJ funded the University of Louisville to develop a statistical model that predicts the probability of head injury occurring as the result of a fall.[3] This project furthers NIJ-funded research at the university that gathered force mechanics data from accelerometers worn by children at a childcare center.[4]
NIJ funding also helped the University of Utah develop a fracture-simulation framework to estimate fall height and impact location from fracture images.[5] Information from these studies allows practitioners to compare a child’s injury to the history a caretaker provides. Then practitioners can evaluate whether the injury and history are consistent or whether they raise concerns about a nonaccidental event.
In addition, NIJ funded a Michigan State University study to investigate the biomechanics associated with skull fractures.[6] Using porcine models, researchers impacted crania with various rigid and soft surfaces at a known force to measure fracture biomechanics and identify recurring fracture patterns.
Bruises
Bruises are common at any age, but specific bruising patterns can be an indicator of nonaccidental injury, especially in infants. NIJ funded the University of Louisville to develop a model to predict bruising patterns associated with accidental household falls (for example, falling from a bed).[7] The researchers developed a virtual bruising detection system using a three-dimensional computer simulation model representing a 12-month-old child to show differences in bruising patterns between accidental and nonaccidental injury.
Injury Identification and Documentation in Autopsies
Identifying and documenting injuries in deceased victims of child abuse is critical to proper adjudication. NIJ has supported research in advanced imaging technologies to augment standard autopsy procedures. NIJ funded the University of New Mexico to evaluate the value of magnetic resonance imaging (MRI) and computed tomography (CT) in death investigations of children with suspected head trauma. The team hypothesized that using postmortem CT in conjunction with standard autopsy will increase the rate of injury identification in deceased children, as it has for adults. The team also investigated the use of three-dimensional postmortem MRI to visualize bleeding within a child’s spinal tissue, a potential mechanism of death.[8]
Since 2007, NIJ has invested more than $11 million to further understand and determine intentional versus accidental trauma, along with cause and manner of death, in infants and children. Such research remains a high priority for NIJ’s Forensic Science Research and Development Technology Working Group.[9] Through these investments, NIJ continues to develop tools that help the forensic science community identify child abuse and advance justice for victims.
About the Article
This article was published as part of NIJ Journal issue 286.
This article discusses the following awards:
- “Development of a Probability Model To Predict Head Injury Risk in Pediatric Falls,” award number 2019-DU-BX-0029
- “Biomechanical Characterization of Video Recorded Short Distance Falls in Children,” award number 2017-DN-BX-0158
- “Forensic Tool To Identify Fall Characteristics in Infant Skull Fracture,” award number 2020-75-CX-0014
- “A Forensic Pathology Tool To Predict Pediatric Skull Fracture Patterns,” award number 2007-DN-BX-K196
- “Pediatric Fracture Printing: Creating a Science of Statistical Fracture Signature Analysis,” award number 2011-DN-BX-K540
- “Utility of Postmortem X-ray Computed Tomography (CT) in Supplanting or Supplementing Medicolegal Autopsies,” award number 2010-DN-BX-K205
- “Investigation of Post-Mortem Magnetic Resonance Imaging for the Detection of Intraneural Hemorrhage,” award number 2013-DN-BX-K004
- “Improving and Evaluating Computed Tomography and Magnetic Resonance Imaging in the Investigation of Fatalities Involving Suspected Head Trauma,” award number 2016-DN-BX-0173
- “Understanding the Pathology of Homicidal Pediatric Blunt Neurotrauma Through Correlation of Advanced Magnetic Resonance Images With Histopathology,” award number 2017-DN-BX-0145
- “Development of a Computer Simulation Model To Describe Potential Bruising Patterns Associated With Common Childhood Falls,” award number 2014-DN-BX-K006