OBJECTIVE: This retrospective cohort study explores the impact of the COVID-19 pandemic on pediatric trauma cases in Singapore\'s National University Hospital from January 2015 to July 2021. The pandemic prompted unprecedented measures, altering societal dynamics. The study hypothesizes a reduction in major trauma incidents during the pandemic period.
METHODS: This is a single-center retrospective study including all pediatric patients presenting with trauma-related ICD-9 codes, and an Injury Severity Score (ISS) greater than 8. Patients were stratified into two time periods: pre-pandemic (January 2015 to March 2020) and pandemic (April 2020 to July 2021) periods.
RESULTS: Out of 254 pediatric trauma cases, 201 occurred pre-pandemic, and 53 during the pandemic. While overall trauma incidence remained similar, the pandemic period saw a shift in injury patterns. Home-based falls increased, vehicular accidents decreased, while deliberate self-harm and caregiver abuse rose significantly. The incidence of serious trauma attributed to non-accidental injury increased during the pandemic.
CONCLUSIONS: The study reveals changing trauma patterns, emphasizing the importance of understanding societal impacts during pandemics. Notably cases of deliberate self-harm and caregiver abuse surged, echoing global concerns highlighted in other studies during the pandemic. The study underscores the need to preempt physical and psychological stressors in vulnerable populations during future pandemics.

UNASSIGNED: Metabolic Bone Disease of Infancy (MBDI) is a multifactorial disorder of bone fragility that presents with multiple unexplained fractures (MUF) and is often misdiagnosed as child abuse. The diagnosis of MBDI is made by the finding of radiographic features of healing rickets and risk factors for MBDI. Our anecdotal experience indicates blood 1,25-dihydroxyvitamin D (1,25-DiOHVD) is sometimes elevated. The purpose of this retrospective study was to review cases of MBDI in which child abuse was alleged and the alleged perpetrator denied wrongdoing.
UNASSIGNED: We reviewed forensic cases of MBDI born between 2015 and 2021. The diagnosis was based on radiographic findings of healing rickets. Records were reviewed for blood 1,25-DiOHVD testing.
UNASSIGNED: 22 of the 76 infants (29 %) had a blood 1,25-DiOHVD level performed at the time of presentation with fractures. The average age of presentation with fractures was 11 weeks.3 of the 22 infants (14 %) had a normal 1,25-DiOHVD blood level, and 19 of the 22 infants (86 %) had an elevated level. None had low levels.
UNASSIGNED: Blood 1,25-DiOHVD is often elevated in infants with MBDI. Elevated blood 1,25-DiOHVD levels cause increased bone resorption and decreased bone mineralization, and thus this finding is not unexpected since all infants had evidence of healing rickets on imaging studies. These results indicate blood 1,25-DiOHVD should be done in contested cases of child abuse in infants with MUF as an elevated level indicates bone fragility.

BACKGROUND: Child abuse refers to any type of mistreatment of a child, perpetrated by a parent, caregiver, or another individual in a custodial capacity, which may lead to instances of physical, sexual, or emotional abuse. Physicians play a crucial role in identifying and managing this phenomenon in the healthcare setting, as the number of unreported cases increases globally.
METHODS: A questionnaire-based cross-sectional study was conducted between 2022 and 2023 among physicians practicing in Saudi Arabia to assess their knowledge, awareness, and attitude toward child abuse. The data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States).
RESULTS: A total of 153 physicians were involved in this study, in which 65 participants (42.5%) indicated poor awareness of child abuse, while 79 participants (51.6%) indicated moderate knowledge of child abuse. Additionally, lack of knowledge was the most common barrier to reporting child abuse in 87 participants (56.9%). A positive significant correlation was identified between awareness and knowledge and between knowledge and attitude. Also, it was found that a higher attitude score was more associated with being male, having less experience, practicing in the emergency medicine department, and working in a governmental hospital.
CONCLUSIONS: These results highlight the significance of implementing specialized training programs and workshops focused on identifying and reporting child abuse, as well as providing guidelines for recognizing signs of abuse and taking appropriate intervention measures.

BACKGROUND: Paediatricians perform medical assessments for children in cases of suspected child maltreatment. Due to their role with statutory child protection agencies and police, paediatricians may be asked to testify in court about child protection and criminal justice matters. To the authors\' knowledge, there has been no previous systematic review of the literature synthesising the evidence on the impacts on paediatricians testifying in cases of child maltreatment.
METHODS: A search strategy comprising indexed and key terms will be applied to six electronic reference databases from inception to May 2023: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts and Cochrane Library. Two reviewers will independently screen titles and abstracts and full-text articles against predefined eligibility criteria to identify studies of interest. Conflicts will be independently adjudicated by a third reviewer.
BACKGROUND: Since the systematic review methodology aims at synthesising information from available publications, this study does not require ethical approval. An article reporting the results of the systematic review will be submitted for publication in a scientific journal, presented at relevant conferences and used in subsequent stakeholder consultations.

Non-accidental trauma (NAT) is a major cause of morbidity and mortality for children around the world and most significantly impacts children under one year of age. Prompt and comprehensive treatment of these children relies on a high index of suspicion from any medical provider that treats pediatric patients. This review discusses those most at risk for experiencing NAT, and common initial presentations, to assist providers in the identification of potential victims. In addition, this review provides guidance on the recommended workup for these patients so that the full extent of associated injuries may be identified and the appropriate healthcare team may be assembled.

BACKGROUND: Birth injury is a significant public health problem in Africa, with a high incidence and associated mortality and morbidity. Systematic reviews that indicate the incidence, contributing factors and outcomes of birth injury in Africa provide valuable evidence to policy-makers and programme planners for improving prevention and treatment strategies. Therefore, this review is aimed to evaluate the incidence, contributing factors and outcomes of birth injury among newborns in Africa.
METHODS: The data will be searched and extracted from JBI Database, Cochrane Database, MEDLINE/PubMed, CINAHL/EBSCO, EMBASE, PEDro, POPLINE, Proquest, OpenGrey (SIGLE), Google Scholar, Google, APA PsycInfo, Web of Science, Scopus and HINARI. Unpublished studies and grey literature will be searched from different sources. This systematic review will include quantitative observational studies, registry and census data, and experimental studies that report on the prevalence or incidence in Africa from 1 January 1990 to 30 September 2023. The Joanna Briggs Institute (JBI) quality appraisal checklist will be used to select eligible studies. Two researchers will independently appraise and extract the data from included studies and resolve discrepancies through discussion. Heterogeneity will be assessed using forest plots and the I2 statistic. If substantial heterogeneity is present, a random-effects model will be used to pool the data. Subgroup analyses will be used to explore the potential sources of heterogeneity. Publication bias will be assessed using funnel plots and Egger\'s regression test. The software package used to conduct the meta-analysis will be JBI SUMARI. An association will be considered significant if the p<0.05.
BACKGROUND: Ethical clearance is not needed for this systematic review and the results will be shared with relevant stakeholders to maximise reach and impact.
UNASSIGNED: CRD42023123637.

Child maltreatment (CM) is a complex global public health issue with potentially devastating effects on individuals\' physical and mental health and well-being throughout the life course. A lack of uniform definitions hinders attempts to identify, measure, respond to, and prevent CM. The aim of this electronic Delphi (e-Delphi) study is to build consensus on definitions and types of CM for use in surveillance and multi-sectoral research in the 34 countries in the Euro-CAN (Multi-Sectoral Responses to Child Abuse and Neglect in Europe) project (COST Action CA19106).
The e-Delphi study will consist of a maximum of three rounds conducted using an online data collection platform. A multi-disciplinary expert panel consisting of researchers, child protection professionals (health and social care), police, legal professionals and adult survivors of CM will be purposefully recruited. We will approach approximately 100 experts, with between 50 and 60 of these anticipated to take part. Participants will rate their agreement with a range of statements relating to operational definitions and types of CM, and free-text comments on each of the statements to give further detail about their responses and areas of uncertainty. Consensus has been defined a priori as ≥70% of the panel agreeing or disagreeing with the statement after the final round. The responses to the open-ended questions will be analysed using a \'codebook\' approach to thematic analysis, and used to refine the statements between rounds where no consensus is reached.
Ethical approval has been granted from the Cardiff University School of Medicine ethics committee (reference number SMREC22/96). Results will be submitted for publication in a peer-reviewed journal and presented at workshops (including for the participants) and international academic conferences. The Euro-CAN network will also be used to disseminate the results, with results briefings and presentations to key public health and other relevant organisations in the field.

Brief interventions that reduce suicide risk following youth\'s experience with acute care due to suicidality are needed.
The study will use a three-arm randomised controlled trial designed to test the effectiveness of the Safety Planning Intervention with structured follow-up (SPI+) and the Collaborative Assessment and Management of Suicidality (CAMS) compared with enhanced usual care. The primary outcomes measure will be suicidal events, defined as death by suicide, attempted suicide, preparatory acts toward imminent suicidal behaviour or suicidal ideation resulting in a change in emergency evaluation or inpatient admission. Secondary measures will be the number of suicide attempts and severity of suicidal ideation. The experimental interventions, SPI+ and CAMS, consist of up to eight sessions over approximately 8 weeks that are designed to manage (SPI+) or treat (CAMS) patient-identified \'drivers\' of suicidal thoughts and behaviours. Mechanisms and moderators of change will be evaluated to understand treatment impacts.
This study has been approved by the Seattle Children\'s Institutional Review Board and is monitored by external agencies including the University of Washington Institute for Translational Health Sciences, and a National Institute of Mental Health (NIMH)-appointed Data Safety and Monitoring Board. Trial results will help establish evidence towards safe and effective treatment strategies for youth transitioning from acute to outpatient care due to a suicidal crisis. The data will be shared with the NIMH Data Archives and disseminated through publications and conferences.
NCT05078970.

OBJECTIVE: To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS.
METHODS: The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre.
RESULTS: The study included 116 patients (71% women, p < .001, χ2), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, χ2) or assault by unknown offender (88% of men, p < 0.002 χ2). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT.
CONCLUSIONS: The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations.
CONCLUSIONS: MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation.
CONCLUSIONS: • Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender. • Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients. • MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation.

UNASSIGNED: Transferring paediatric patients with suspected abusive head trauma (AHT) to paediatric neurosurgical centres, disrupts safeguarding investigations. Therefore, it is desirable that suspected AHTs are transferred only when clinically necessary. The aim of this study was to describe referral patterns of patients referred to a tertiary paediatric neurosurgical centre with suspected AHT, with the view of informing future transfer of AHT patients.
UNASSIGNED: A retrospective review was performed of all suspected AHT patients referred to the University Hospital of Wales between 2012 and 2021.
UNASSIGNED: Rates of surgery, intubation and ventilation, radiological findings and presenting GCS were compared between referred patients and those transferred for neurosurgical care. Variables were compared between the transferred and the non-transferred groups. For categorical variables, Chi-squared tests were performed, with Fisher\'s exact test used where the expected count was less than 5. Odds ratios (OR) for neurosurgical transfer with radiological or clinical features at presentation were calculated.
UNASSIGNED: A total of 76 patients were referred, of which 18 were transferred for neurosurgical care. Of these, six were intubated and ventilated. Only one transferred patient required surgery, with the remainder receiving supportive care. Amongst the transferred group, 77.8% had SDHs and 68.6% had a GCS ≥ 13 at presentation. Patients with a GCS ≥ 13 and SDHs, bilateral haematomas or a history of vomiting were significantly more likely to be transferred (OR = 4.27, 95%CI 1.01-18.00, p = .05).
UNASSIGNED: Most transferred patients with suspected AHT did not receive surgical intervention. We suggest that patients should be transferred when it is likely that they will require surgery, otherwise they should stay locally in order to complete their safeguarding investigations. Immediate transfer may not be necessary for AHT patients with a GCS ≥ 13 and either vomiting, SDHs or bilateral haematomas, provided they are unlikely to require emergency surgery.