Inconsistent injuries are those that are not congruent with the story that is offered in explanation of the injury. These injuries can also be suspected, if a patient or caregiver offers an explanation of the trauma that does not coincide with accidents or injuries common for the patient’s age group. An injury such as perforated ear drums is commonly associated with head trauma and should be investigated further.
Abuse may be suspected, if there is a delay in seeking treatment. Reasons for the delay can include lack of perceived urgency, or fear that the truth of the injury will be revealed. Victims of abuse will often claim that they are accident prone, in order to justify their frequent visits to the emergency department or clinic.
A healthcare provider may suspect abuse if, upon examination, previous injuries are discovered. Partially healed fractures or bruises could indicate trauma(s) that have gone unreported and untreated.
Burns that appear in the exact shape of the offending object are suspect injuries. Clearly outlined burns from easily-recognizable objects, such as cigarettes or household irons usually indicate abuse. This type of injury cannot typically be attributed to an accident.
A sexually transmitted infection, when diagnosed in any child, is indicative of abuse. Physical trauma to the genitals or perineal area may also occur as the result of sexual abuse. Excessive masturbation and sexual promiscuity may indicate symptoms of sexual abuse in children.
Torn undergarments, in addition to bruising or bleeding in the genital area, are possible signs of physical or sexual abuse in children. Newly developed difficulty with sitting or standing should also be assessed when sexual abuse is suspected, as this can be a behavioral manifestation of genital trauma.
Shaken baby syndrome is associated with violent shaking of an infant or small child. Consequences of this injury are primarily internal with no visible signs of external injury. Medical findings include subdural hematomas, cranial fractures, swelling of the brain, and retinal bleeding. This syndrome can lead to potentially life-threatening complications, such as altered breathing, central nervous system depression, and coma.
Unmaintained physical hygiene is characteristic of neglect in the elderly population. The overall physical health and well-being of the patient should be assessed, if poor hygiene is suspected to be the result of neglect.
Polypharmacy is a common phenomenon among the elderly. Over-medication can become abusive, if medications are administered with the intent to calm or sedate an elderly individual, when it is not appropriate or medically necessary.
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