Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Shannon Carpenter
Presentation Type
Poster
Start Date
20-5-2026 11:00 AM
End Date
20-5-2026 12:00 PM
Abstract Text
Background:
The most common presentation for both pediatric non-accidental trauma (NAT) and bleeding disorders is bruising. In non-mobile infants with bruising, NAT evaluation is recommended.
Objectives/Goal:
We aimed to assess complete evaluation for NAT in patients < 9 months of age presenting with bruising and/or bleeding to our pediatric hematology clinic, and frequency of diagnosis of NAT.
Methods/Design:
A single center retrospective chart review was performed on children < 9 months at time of evaluation referred to pediatric hematology from 1/1/2016 to 12/31/2025. Patients were eligible if their visit included ICD-10 diagnosis codes for bleeding and/or bruising, ICD-10 codes for bleeding disorders, ICD-10 codes for non-accidental trauma, or visit reason listed as bleeding and/or bruising. Patients were excluded if asymptomatic but seen due to family history, for follow-up from the neonatal intensive care unit (NICU) or newborn nursery, or if they were presenting for another clinical reason. Demographics, symptoms, family history of bleeding disorders, bleeding disorder and/or NAT evaluation performed, and diagnoses of bleeding disorders and/or NAT were collected. NAT evaluation was deemed complete if the following were obtained: head imaging (computed tomography), skeletal survey, aspartate aminotransferase level (AST), and alanine aminotransferase level (ALT).
Results:
100 patients were identified, with 26 included. Most were excluded due to being asymptomatic with known family history or presenting for follow-up from the newborn nursery or NICU. 11 patients (42.3%) were diagnosed with NAT, and 7 patients (26.9%) were diagnosed with a bleeding disorder. 1 patient was diagnosed with both a bleeding disorder and NAT.
16 patients (61.5%) received complete evaluation for NAT and 5 patients (19.2%) underwent partial evaluation (e.g. imaging only). 5 patients (19.2%) received no NAT evaluation. Of those with no evaluation, 3 presented with petechiae only, 1 presented with a family history of hemophilia B and bruising after a witnessed fall, and 1 presented as a referral from an outside institution without complete records of prior evaluation.
10 (38.5%) patients had no NAT evaluation prior to their hematology clinic appointment, with the other 16 (61.5%) having previously received imaging and/or laboratory evaluation in the emergency department (ED), inpatient admission, or our institution’s child abuse pediatrics clinic. Of the 11 patients diagnosed with NAT, 2 received no evaluation before their hematology appointment. One was a 2-month-old presenting with bruising, who was appropriately referred to the ED after clinic arrival. The second patient presented at 7 months of age for bruising; initial workup did not identify a bleeding disorder. The infant returned the following month for further testing, which was diagnostic for a mild platelet function disorder. A skeletal survey was also performed and diagnostic for NAT.
Conclusions:
Infants with symptomatic bruising and/or bleeding symptoms are infrequently seen in the hematology clinic. However, bleeding disorders and NAT are both present in this population. Evaluation for these conditions is of critical importance as missed diagnosis of either could be catastrophic.
Evaluation for non-accidental trauma (NAT) and bleeding disorders in infants referred to pediatric hematology
Background:
The most common presentation for both pediatric non-accidental trauma (NAT) and bleeding disorders is bruising. In non-mobile infants with bruising, NAT evaluation is recommended.
Objectives/Goal:
We aimed to assess complete evaluation for NAT in patients < 9 months of age presenting with bruising and/or bleeding to our pediatric hematology clinic, and frequency of diagnosis of NAT.
Methods/Design:
A single center retrospective chart review was performed on children < 9 months at time of evaluation referred to pediatric hematology from 1/1/2016 to 12/31/2025. Patients were eligible if their visit included ICD-10 diagnosis codes for bleeding and/or bruising, ICD-10 codes for bleeding disorders, ICD-10 codes for non-accidental trauma, or visit reason listed as bleeding and/or bruising. Patients were excluded if asymptomatic but seen due to family history, for follow-up from the neonatal intensive care unit (NICU) or newborn nursery, or if they were presenting for another clinical reason. Demographics, symptoms, family history of bleeding disorders, bleeding disorder and/or NAT evaluation performed, and diagnoses of bleeding disorders and/or NAT were collected. NAT evaluation was deemed complete if the following were obtained: head imaging (computed tomography), skeletal survey, aspartate aminotransferase level (AST), and alanine aminotransferase level (ALT).
Results:
100 patients were identified, with 26 included. Most were excluded due to being asymptomatic with known family history or presenting for follow-up from the newborn nursery or NICU. 11 patients (42.3%) were diagnosed with NAT, and 7 patients (26.9%) were diagnosed with a bleeding disorder. 1 patient was diagnosed with both a bleeding disorder and NAT.
16 patients (61.5%) received complete evaluation for NAT and 5 patients (19.2%) underwent partial evaluation (e.g. imaging only). 5 patients (19.2%) received no NAT evaluation. Of those with no evaluation, 3 presented with petechiae only, 1 presented with a family history of hemophilia B and bruising after a witnessed fall, and 1 presented as a referral from an outside institution without complete records of prior evaluation.
10 (38.5%) patients had no NAT evaluation prior to their hematology clinic appointment, with the other 16 (61.5%) having previously received imaging and/or laboratory evaluation in the emergency department (ED), inpatient admission, or our institution’s child abuse pediatrics clinic. Of the 11 patients diagnosed with NAT, 2 received no evaluation before their hematology appointment. One was a 2-month-old presenting with bruising, who was appropriately referred to the ED after clinic arrival. The second patient presented at 7 months of age for bruising; initial workup did not identify a bleeding disorder. The infant returned the following month for further testing, which was diagnostic for a mild platelet function disorder. A skeletal survey was also performed and diagnostic for NAT.
Conclusions:
Infants with symptomatic bruising and/or bleeding symptoms are infrequently seen in the hematology clinic. However, bleeding disorders and NAT are both present in this population. Evaluation for these conditions is of critical importance as missed diagnosis of either could be catastrophic.
Comments
Poster Board Number: 11