Evaluation for Nonaccidental Trauma and Bleeding Disorders in Infants Referred to Pediatric Hematology

The most common presentation for both pediatric nonaccidental trauma (NAT) and bleeding disorders is bruising. In nonmobile infants with bruising, NAT evaluation is recommended. We aimed to assess the evaluation for NAT in patients below 9 months of age presenting with bruising and/or bleeding to our pediatric hematology clinic. A single-center retrospective chart review was performed on children aged below 9 months referred to pediatric hematology. Patients were eligible if their visit included ICD-10 diagnosis codes for bleeding and/or bruising, bleeding disorders, or nonaccidental trauma, or if the visit reason was listed as bleeding and/or bruising. Demographics, symptoms, family history, diagnostic evaluation performed, and diagnoses were collected. 26 infants were included. Twelve (46.2%) received a complete evaluation for NAT, and 9 (34.6%) underwent a partial evaluation. A total of 5 patients (19.2%) received no NAT evaluation. A total of 11 patients (42.3%) were diagnosed with NAT, and 7 (26.9%) were diagnosed with a bleeding disorder. Only 1 patient was diagnosed with both a bleeding disorder and NAT. Of the 11 patients ultimately diagnosed with NAT, 2 received no evaluation before hematology evaluation. This study highlights the importance of thorough evaluation for abuse and bleeding disorders alongside ongoing coordination between hematologists and child abuse pediatricians.