THE SCENE is familiar; you've been there before. You, the physician, are in the emergency department examining a 2-year-old child with a femur fracture who "fell down the stairs." The referring physician at an outside clinic has already informed Child Protective Services that the injury is suspicious for abuse. You wonder,
As physicians caring for injured patients, our clinical thinking is continually, if subtly, influenced by biomechanics. We take for granted our relatively superficial understanding that 65-mph motor vehicle crashes carry a high risk of occupant injury or that falls from a 7-story window will lead to a critical injury. In these cases, our patients are on the extreme end of the energy-injury curve, so we feel confident making fairly safe judgments about the compatibility of the injury with the historical account. On the other extreme, we have also come to accept (albeit more slowly) that trivial falls from very short heights are unlikely to explain severe brain injuries in a child.1
Grossman DC. Computer Simulation: A Powerful Tool for Injury Control. Arch Pediatr Adolesc Med. 2001;155(9):992–993. doi:10.1001/archpedi.155.9.992
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