In Japan the number of child abuse cases increases gradually and approaches about 60,000 cases fiscal 2011. A number of neurosurgeons have an experience to child abuse head trauma cases. Since the child abuse prevention law was established fiscal 2000, the opportunity that neurosurgeons were pressed to make the decision against discrimination abuse head trauma case from accidental head trauma case is expanded.
The cause of over 95% severe head injury cases until one-year-old children is abuse. If we do not take counter measure about these abuse cases and discharge these children from hospital to their house, 5% cases will be dead and 25% cases will be come back to the hospital as same situation. Not only neurosurgeons but also pediatricians, medical social workers, and the child consultation center staff deal with the abuse cases together.
At out hospital from November 2001 to April 2014, 72 child abuse cases were reported and 19 cases were involved with neurosurgical problems. In these 19 cases, 8 cases were treated at intensive care unit, and 4 cases were dead within two weeks from admission. 9 cases were acute subdural hematoma, 2 cases were chronic subdural hematoma, 1 case was diffuse axonal injury, and 7 cases were skull bone fracture or concussion. 4 cases were needed the surgical treatment.
In our hospital, the child abuse team including neurosurgeons, pediatricians, and medical social workers intervene directly in these abuse cases as soon as possible. But after discharge, we cannot follow up all cases because there are some cases not returning for outpatient clinic. So we should establish the social and medical structure needed to support abused children and their family.
