The Worst Missed Diagnosis of All: The Incorrect Diagnosis of Child Abuse

There are many mimics of child abuse that bring children to medical attention, including bruises and bleeding. Approximately 1 and 20 children evaluated for abuse in a large study involving nearly 3000 children were ultimately found to suffer from an underlying disorder that predisposed to bleeding rather than from intentional injury to the child. There are many common bleeding disorders that are often overlooked leading to an incorrect diagnosis of child abuse. These include von Willebrand disease, hemophilia A and hemophilia B and their carrier states, idiopathic thrombocytopenic purpura, and dozens more. The complexity associated with the diagnosis of a bleeding disorder requires appropriate and thorough testing and correct interpretation of the results. This information is often beyond the content knowledge of individuals who participate clinically in a child abuse program. The need for consultation on all questionable cases associated with bleeding or bruising with an established expert who has substantial expertise in bleeding disorders is absolutely essential before determining that a bleeding or bruised child is the victim of an intentional injury. This presentation presents concepts and case examples of incorrect diagnoses and the consequences that resulted from each diagnostic error.