Medicolegal Approach to Child Physical Abuse in an Emergency Clinic

Abstract

Child abuse is a global health problem. For this reason, it is important to perform suitable medical approaches in suspected cases of child abuse in the emergency room. The first consideration is performing life-saving medical approaches. Reporting the case to judicial authorities and the correlation of medical examination findings with medicolegal history are other important steps. We report a case of a 3-year-old male child who died after severe physical abuse. In suspected cases of child abuse, examination of the fundus is important. If death occurs, histopathological examination of eye globes must be performed to determine the cause of death. The present case was the first in which eye globe examination was performed in Izmir, Turkey. Autopsy findings revealed subdural hemorrhage and subarachnoid hemorrhage caused by blunt trauma. The cause of death was blunt head trauma, and the manner of death was listed as homicide. Except for microhemorrhages in the optic nerve sheath, no pathological finding was identified in the retina. Retinal hemorrhage can be seen in child abuse cases, and it is associated with a poor prognosis if present; however, the absence of retinal hemorrhage does not exclude child abuse. Crime scene investigation findings, witnesses' statements, medical records, and autopsy findings must all be taken into consideration in child abuse cases in a correlative and holistic manner.