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The researchers found that when a child presented with neurological symptoms after head injury and parents or caregivers reported no history of trauma, such as a fall or being hit with a hard object, that the injury was highly likely to be caused by abuse. In medical terms, the history is the initial report of what happened prior to injury.

"In every single case where there was no history of trauma and the child ended up with neurological damage, it was later determined that the injury was caused by abuse," says Joeli Hettler, MD, assistant in Emergency Medicine and lead author of the study. "Either the parents did not 'make up a story' of how their kids were hurt, or their initial claims of not knowing what happened or of a minor injury, did not coincide with the observed injuries."

In order to assess whether abuse has occurred, physicians evaluate medical test results and take a history (an account of the patient's past and present health and family and personal background). Children's researchers set out to assess this history -- or report of what happened -- to see if it could effectively predict whether a child's injury was caused by abuse.

Additionally, researchers found that among the subgroup of patients with persistent neurologic abnormality at hospital discharge, those who did not have a history of high-impact (defined as a fall greater than 3 feet) trauma were all victims of child abuse. The researchers combined cases that reported no history of trauma with those that reported a history of low-impact (defined as a fall from less than 3 feet) trauma and found that, in both cases, these reports were predictive for abuse. This is consistent with data from a prior Children's Hospital study that showed that low-impact trauma is unlikely to result in neurological impairment.

The third relevant finding was that when caregivers or parents attributed injuries to their own vigorous attempts to resuscitate a child, abuse was the cause of injuries in every case. Lastly, in cases where parents changed their stories or whose reported histories changed over the course of their treatment at the hospital, abuse was again determined to be the cause of injury in all cases.

Over 3 million cases of child abuse and neglect are reported annually, a rate of 44 per 1000 children. Each year, 160,000 children suffer severe or life-threatening injuries and 1,000 to 2,000 children die as a result of abuse. Physical abuse is the leading cause of serious head injury in infants. Although physical abuse in the past has been a diagnosis of exclusion, data regarding the nature and frequency of head trauma consistently support the need for a presumption of child abuse when a child younger than 1 year has suffered an intracranial injury. Head injuries are the leading cause of traumatic death and the leading cause of child abuse fatalities.

Previous research has shown that serious injuries in infants, particularly those that result in death, are rarely accidental unless there is another clear explanation, such as trauma from a motor vehicle crash. Billmire and Meyers found that when uncomplicated documented severe trauma such as that resulting in skull fractures were excluded, 95 percent of serious intracranial injuries and 64 percent of all head injuries in infants younger than 1 year were attributable to child abuse. Bruce and Zimmerman documented that 80 percent of deaths from head trauma in infants and children younger than 2 years were the result of non-accidental trauma.

[Above two paragraphs are attributable to the American Academy of Pediatrics Committee on Child Abuse and Neglect, 2000-2001.]