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Biomedical subjects

R M Reece

Publications and source records attributed to R M Reece.

At least 19 recordsLinked to original sources
PubMed2000

Childhood head injuries: accidental or inflicted?

OBJECTIVES: To determine the relative incidence of accidental and abusive causes of head injuries in children younger than 6.5 years, to identify the types of craniocerebral damage resulting from reported mechanisms of injury, and to assess the likelihood of injuries being accidental or inflicted. METHODS: Retrospective review of medical records of 287 children with head injuries aged 1 week to 6.5 years admitted to a metropolitan children's hospital from January 1986 through December 1991. Those patients with diagnoses of skull fracture; concussion; subarachnoid hemorrhage (SAH); subgaleal, epidural, or subdural hematoma (SDH); parenchymal contusion or laceration; and closed head injury were included. Criteria were used for inclusion in categories of definite abuse or accident. RESULTS: Accidents accounted for 81% of cases and definite abuse for 19%. The mean age of the accident group was 2.5 years and for the definite abuse group, 0.7 years. Major differences were seen in the incidence of the following: SDH, 10% in the the accident group and 46% in the the definite abuse group; SAH, 8% in accident group and 31% in the definite abuse abuse; and retinal hemorrhages, 2% in the accident group and 33% in the definite abuse group. Associated cutaneous injuries consistent with inflicted injury were seen in 16% of the accident group and 50% of the definite abuse group. Twenty-three percent of those in the accident group were injured in motor vehicle crashes (MVCs), 58% by falls, 2% in play activities, and the rest had insufficient medical record information. In 56% of those in the definite abuse group, there was no history to account for the injuries and no history of MVC. In 17%, a fall was said to have been the mechanism of injury. In 24%, inflicted injury was admitted. Mortality rates were 13% in the definite abuse group and 2% in the accident group. Median hospital stay was 9.5 days for the definite abuse group and 3 days for the accident group. In falls less than 4 feet in the accident group, 8% had SDH, 2% had SAH, and none had retinal hemorrhages; among those in the definite abuse group reportedly falling less than 4 feet, 38% had SDH, 38% had SAH, and 25% had retinal hemorrhages. CONCLUSIONS: A substantial percentage of head injuries requiring hospitalization in children younger than 6.5 years are attributable to inflicted injury. Subdural hematoma, subarachnoid hemorrhage, retinal hemorrhages, and associated cutaneous, skeletal, and visceral injuries are significantly more common in inflicted head injury than in accidental injury.

Accidental Falls↗
PubMed2000

Child abuse and unintentional injuries: a 10-year retrospective.

OBJECTIVE: To identify differences between hospitalized children injured by child abuse and those with unintentional injuries. DESIGN: Comparative analysis of patients injured by child abuse (n = 1997) with patients injured unintentionally (n = 16 831), newborn to 4 years of age. MAIN OUTCOME MEASURES: Patient characteristics, nature and severity of injury, treatment, length of stay, survival, functional limitations, and disposition at discharge from the hospital. DATA SOURCE: Retrospective review of medical records submitted to the National Pediatric Trauma Registry between January 1, 1988, and December 31, 1997. RESULTS: During the 10-year study period, child abuse accounted for 10.6% of all blunt trauma to patients younger than 5 years. Children injured by child abuse were significantly younger (mean, 12.8 vs 25.5 months) and were more likely to have preinjury medical history (53% vs 14.1%) and retinal hemorrhages (27.8% vs 0.06%) than children with unintentional injuries. Abused children were mainly injured by battering (53%) and by shaking (10.3%); unintentionally injured children were hurt mainly by falls (58.4%) and by motor vehicle-related events (37.1%). Abused children were more likely than unintentionally injured children to sustain intracranial injury (42.2% vs 14.1%) and thoracic (12.5% vs 4.5%) and abdominal (11.4% vs 6.8%) injuries; to sustain very severe injuries (22.6% vs 6.3%); to be admitted to the intensive care unit (42.5% vs 26.9%); and to receive Child Protective Services (82.3% vs 8%) and Social Services (72.9% vs 27.6%) intervention. The mean length of stay for children who were abused was significantly longer (9.3 vs 3.8 days) and the survival to discharge from the hospital was significantly worse (87.3% vs 97.4%) than for those unintentionally injured. Among the survivors, children who were abused developed extensive functional limitations more frequently than those unintentionally injured (8.7% vs 2.7%). More than half (56.6%) of the children who were abused were discharged to custodial/foster/Child Protective Services care; most (96.1%) of the children unintentionally injured returned to their homes. CONCLUSIONS: Child abuse continues to be a serious cause of mortality and morbidity to infants and toddlers. On average, among children hospitalized for blunt trauma, those injured by abuse sustain more severe injuries, use more medical services, and have worse survival and functional outcome than children with unintentional injuries.

Case-Control Studies↗
PubMed1990

Unusual manifestations of child abuse.

Cases of child abuse are seen each day in the clinics, emergency departments, private offices, and public and private hospitals. Unusual presentations are intermixed with the straightforward, conventional, and well-understood cases. Fatal pepper aspiration, abdominal injuries ranging from rents in the liver and spleen, transection of the pancreas, and traumatic pseudocysts of that organ are described here. The triad of signs dubbed the "tin ear syndrome" consists of bruising of the ear, retinal hemorrhages, and cerebral edema. Toxic ingestions, mainly of cocaine, and its related paraphernalia are described in addition to peculiar tissue-specific microwave oven burns, an inflicted injury that rational minds find hard to comprehend. Finally, the bizarre syndrome of Münchausen by proxy is reviewed, and some understanding of the dynamics of this disorder has begun. Knowledge about these diagnostic oddities will enable us to intervene and attempt to alter the outcome in these dysfunctional families. The authors would welcome other case reports of unusual manifestations of child abuse, neglect, and child sexual abuse.

Child↗
PubMed1987

Sudden and unexpected death. The pediatrician's response.

When an infant dies suddenly and unexpectedly, the sense of loss and terrible grief may overwhelm not only the parents but also the physician. When that sudden death is due to a known cause, the concrete character of the event can be incorporated into the normal rationalization of mourning. However, when death is due to an unknown mechanism, as in the sudden infant death syndrome, feelings of inadequacy in caring for the child are reinforced. The essential need for support of these families is clear. For physicians, this kind of loss is disquieting and anxiety-provoking. Forty-seven physicians responded to a survey exploring the relationship between the physician and the family after the death of an infant, the feelings of the physician about the death and his or her own sense of loss, and the physician's need for personal support and educational preparation for such an event. While 41 of the physicians indicated they had discussed the death with the family, six had made no contact with the survivors. Thirty-six of the respondents indicated that their relationship with the family continued, and ten physicians stated that their relationship terminated after the death. Physicians characterized their initial responses to the death as frustration, sadness, shock, anger, guilt, regret, hurt, and inadequacy. Most of the physicians believed that they had "missed" something and feared they might be blamed for the death. The competence, sincerity, and sensitivity shown to families during this tragic experience can positively influence the family's mourning and recovery. The pediatrician can provide a rational voice and a medical understanding of tragedy without blame.

Anxiety↗
PubMed1985

Recognition of nonaccidental injury.

Intentional injuries may be grossly underrecognized and underreported. The authors review the literature, provide guidelines for recognizing intentional injuries, and address the problem of identifying intentional injuries. Prevention of these injuries is also addressed and the need for further study is stressed.

Accident Proneness↗
PubMed1983

Child abuse and neglect.

The professional who must deal with child abuse has to resist the urge to punish the offenders and concentrate instead on seeking the best solution for the child. Guidelines for distinguishing child abuse from accidental injury are presented and management of the sexually abused child is detailed.

Child↗
PubMed1980

Observations of paternal response to sudden unanticipated infant death.

Support provided to families experiencing the loss of an infant to sudden infant death syndrome has focused on the description of maternal bonding and the consequences to the mother. However fathers also develop significant relationships with their infants, and their responses to the unanticipated loss of their children may be different than those of mothers. In this study 28 fathers who lost infants to SIDS appeared to have identifiable patterns of behavior which were more peculiar to men: (1) the necessity to "keep busy" with increased work; (2) feelings of diminished self-worth; (3) self-blame because of lack of "care" involvement; and (4) a limited ability to ask for help. That men should be stoic and less emotional and that one need not be concerned with the reactions of fathers appears to be a reflection of societal attitudes. However, these paternal behaviors, which emerge at a time of crisis and which obstruct full expression of grief, may unwittingly be promoted by medical and health care providers who are anxious to help fathers fulfill societal expectations of masculine strength.

Adolescent↗
PubMed1976

Erythema nodosum.

Erythema nodosum (EN) is now more commonly associated with streptococcal disease than with tuberculosis. Sarcoidosis is the third most frequently associated systemic disease. Oral contraceptives now lead the list of drugs associated with EN. The appearance and disappearance of crops of nodules is extremely variable. Salicylates and rest are useful. Steroids are not recommended because they may compromise defenses against an underlying disease process.

Diagnosis, Differential↗
PubMed1976

Anorexia nervosa.

Anorexia nervosa occurs predominantly in white, middle-class, adolescent females with perfectionistic tendencies. Their solution to the intense guilt induced by any sensory pleasure is to deny themselves the pleasure of eating. Amenorrhea is universal. Diagnostic criteria include a 25 percent weight loss. Therapies are long and involved different approaches. All recognize that food is the medicine for the body and that some form of supportive psychotherapy is the medicine for the mind.

Adolescent↗
PubMed1973

Enuresis.

Explore the source record for details and available documents.

Anxiety↗