In anticipation of EM Cases Episode 107 on Pediatric Physical Abuse with Dr. Carmen Coombs and Dr. Alyson Holland, Dr. Coombs tells her Best Case Ever (actually worst case ever) that inspired her to pursue expertise in pediatric physical abuse…

Podcast production, editing and sound design by Anton Helman, March 2018

Sentinel injuries are minor injuries with major significance

Much as with sentinel bleeds of subarachnoid hemorrhages, even seemingly trivial injuries of abuse can be viewed a “sentinel events” for much worse outcomes in the future. According to Sheets et al in 2013, as many as 25% of abused infants had prior sentinel injuries.

A sentinel injury in infants may appear minor, and can be a precursor to ongoing/escalating abuse. One reason we miss physical abuse in these kids is that most sentinel injuries are minor injuries such as bruises, intraoral injuries, or simple fractures and we overlook the real significance of these injuries, which is that they provide an opportunity for us to intervene before more serious injury occurs. As EM providers, recognizing and responding appropriately to sentinel injuries protects kids. Failure to do so can result in repeated abuse and subsequent morbidity and mortality.