Search

INTRODUCTION Les décès de nourrissons par traumatisme crânien non accidentel s’inscrivent dans une procédure médico-judicaire pouvant compliquer les démarches de prélèvement multi-organes. L’objectif de cette étude est de décrire les pratiques du prélèvement d’organes chez ces nourrissons en état de mort encéphalique en France. METHODES Une enquête nationale rétrospective a été menée d’Avril à Décembre 2018 auprès des 33 coordinations de prélèvement d’organes pédiatriques et des 28 instituts médico-légaux. Le recueil de données a porté sur les cas recensés entre 2013 et 2017. RESULTATS Seize cas ont été recensés. La prise en charge des traumatismes crâniens non accidentels éligibles au prélèvement d’organes est très hétérogène selon les centres. Les coordinations considèrent que la judiciarisation des dossiers représente le principal obstacle au prélèvement. Seuls 6 des instituts médico-légaux approuvent systématiquement le prélèvement multi-organes dans ce contexte, 11 estimant qu’il pourrait empêcher la mise en évidence de lésions thoraco-abdominales, compromettre l’interprétation de certaines lésions ou encore la détermination des causes de la mort. CONCLUSION Une uniformisation des pratiques du prélèvement multi-organes incluant une collaboration étroite entre réanimateurs, coordinateurs, légistes et magistrats sont indispensables pour faciliter le prélèvement d’organes pédiatriques dans les situations médico-judiciaires le permettant, afin d’augmenter la disponibilité des greffons compatibles aux nourrissons en attente de greffe en France.

Resume But de l’etude La population des personnes placees en garde a vue constitue une niche sentinelle peu representee des « panels habituels » des etudes de sante publique. Il s’agit ici de faire un etat des lieux de leur detournement de medicaments. Patients et methodes Etude retrospective sur base de donnees des mesusages dans un echantillon de personnes gardees a vue examinees entre 2015 et 2016 a l’unite medicojudiciaire de l’hopital Hotel-Dieu–Paris. Resultats Parmi 5 149 examens medicaux, 302 cas relevaient d’un trouble de l’usage de substance ou d’un usage detourne de medicaments. En 2016, le nombre de notifications pour usage detourne de clonazepam augmente (n = 65) ; la population d’usagers semble se rajeunir (âge moyen = 23,5 ans) et se fournir majoritairement par deal (63 %). Concernant les traitements de substitution aux opiaces, les indicateurs d’abus et de detournement se confirment tandis que le sulfate de morphine se demarque par une forte part de deal (> 75 %), d’injection IV (62 %) et de polyconsommations, notamment methadone, cocaine (62 %). Conclusion Des resultats obtenus, enquetes nationales en population generale et etudes menees en contexte de privation de liberte, les personnes placees en garde a vue constituent un reel barometre du marche parallele des medicaments de rue. Les repercussions cliniques peuvent etre majeures, une meilleure surveillance est necessaire. Pour les soignants, il s’agit aussi de mieux reperer ces mesusages, troubles de l’usage de substances pour orientation future des patients.

How to take care Of a victim of sexual Assault in the doctor's Office ? The care of a victim of sexual assault is a legal And medical emergency. Before 48 hours, an Initial medical certificate will describe any lesions. A prescription for antiretroviral therapy and emergency Contraception will be made before a possible Complaint is lodged and examination at the Medico-forensic unit (umj). After 48 hours, Contraception and testing for sexually transmitted Disease may still be indicated. Secondly, referral To specialized associations and psychological Support will be systematically offered. From 2018 To 2020, 1,127 sa victims were received at the Umj of the hôtel-dieu de paris: 48% were Between 18 and 25 years old, 31% between 26 And 35 years old and 21% over 35 years old. The Victims had intentionally consumed alcohol in 53% of cases and other toxicants or treatment Related.Comment prendre En charge une victime D’agression sexuelle Au cabinet médical ? La prise en charge d’une victime d’agression Sexuelle (as) constitue une urgence judiciaire et Médicale. Avant 48 h, un certificat médical initial Décrit les éventuelles lésions. Une trithérapie Antirétrovirale et une contraception d’urgence Doivent être prescrites avant le possible dépôt de Plainte et l’examen à l’unité médico-judiciaire(umj).Après 48 h, une contraception et une Recherche d’ist peuvent rester indiquées. Dans Un second temps, une orientation vers des associations Spécialisées et une prise en charge Psychologique seront systématiquement proposées. De 2018 à 2020, 1 127 victimes d’as ont Eté reçues à l’umj de l’hôtel-dieu de paris : 48 % Avaient entre 18 et 25 ans, 31 % entre 26 et 35 ans et 21 % plus de 35 ans. Les victimes Avaient consommé volontairement de l’alcool dans 53 % des cas et d’autres toxiques ou un traitement En lien avec une pathologie psychiatrique Dans 20 % et 10 % des cas respectivement.L’étude a mis en évidence la problématique de Ces agressions dans un contexte d’alcoolisation Festive. Le rôle du médecin traitant est primordial Auprès de ces victimes et afin de les guider tout Au long de leur prise en charge.

Key Points Question Are clinical guidelines for the early detection and diagnostic workup of child physical abuse complete, clear, and consistent across high-income countries? Findings In this systematic review that included 20 clinical guidelines issued in 15 countries, guidelines were clear but incomplete and discrepant, particularly in the definition of sentinel injuries and in recommendations for exploratory laboratory testing and advanced imaging. Meaning This systematic review found a lack of standardized guidelines for the identification and management of child physical abuse, which may contribute to practice variation., This systematic review evaluates the completeness, clarity, and consistency of guidelines from high-income countries for the detection and diagnosis of child physical abuse., Importance The highly variable practices observed regarding the early detection and diagnostic workup of suspected child physical abuse contribute to suboptimal care and could be partially related to discrepancies in clinical guidelines. Objective To systematically evaluate the completeness, clarity, and consistency of guidelines for child physical abuse in high-income countries. Evidence Review For this systematic review, national or regional guidelines that were disseminated from 2010 to 2020 related to the early detection and diagnostic workup of child physical abuse in infants aged 2 years or younger by academic societies or health agencies in high-income countries were retrieved. The definitions of sentinel injuries and the recommended diagnostic workup (imaging and laboratory tests) for child physical abuse were compared. Data were analyzed from July 2020 to February 2021. Findings Within the 20 included guidelines issued in 15 countries, 168 of 408 expected statements (41%) were missing and 10 statements (4%) were unclear. Among 16 guidelines characterizing sentinel injuries, all of them included skin injuries, such as bruises, hematoma, or burns, but only 8 guidelines (50%) included intraoral injuries and fractures. All 20 guidelines agreed on the indication for radiological skeletal survey, head computed tomography, and head magnetic resonance imaging but differed for those of bone scintigraphy, follow-up skeletal survey, spinal magnetic resonance imaging, cranial ultrasonography, chest computed tomography, and abdominal ultrasonography and computed tomography. Additionally, 16 guidelines agreed on exploring primary hemostasis and coagulation but not on the tests to perform, and 8 guidelines (50%) mentioned the need to investigate bone metabolism. Conclusions and Relevance These findings suggest that guidelines for the diagnosis of child physical abuse in infants were often clear but lacked completeness and were discrepant on major issues. These results may help identify priorities for well-designed original diagnostic accuracy studies, systematic reviews, or an international consensus process to produce clear and standardized guidelines to optimize practices and infant outcomes.

Resume But de l’etude La reforme de la medecine legale de decembre 2010 a impose une nouvelle organisation des activites medicolegales en France. Elle a instaure une prise en charge psychologique des victimes, et cree des postes de psychologues au sein des unites medicojudiciaires (UMJ). L’objectif de l’etude est d’analyser les pratiques psychologiques au sein des UMJ francaises huit ans apres la mise en place de la reforme de la medecine legale. Participants et methodes Deux questionnaires anonymes ont ete construits, l’un s’adressant aux psychologues travaillant au sein des UMJ, l’autre aux chefs de service des UMJ. Resultats Quarante-huit pour cent des psychologues et 49 % des chefs de service ont repondu aux questionnaires. Les constats correspondent en grande partie aux preconisations etablies par la reforme. Ces professionnels sont unanimes pour constater la bonne integration de la pratique psychologique au sein des UMJ. Les psychologues remplissent plusieurs missions : prise en charge des victimes (accompagnement, psychotherapie) et interventions aupres du personnel (formation, accompagnement). Ils participent parfois a l’evaluation du retentissement psychologique des victimes. Conclusion Des evolutions sont proposees : harmonisation des pratiques psychologiques au sein des UMJ au niveau national, et organisation d’une conference de consensus sur l’evaluation du retentissement psychologique.

BACKGROUND:Abusive head trauma (AHT) warrants particular attention in terms of prevention. One of the key questions asked is how often AHT occurs in infant day care centers compared with private parental or nonparental homes. To investigate this, we studied the caretaking arrangement and child’s location at the time of injury in a cohort of cases involving AHT from the courts.METHODS:This multicenter retrospective study covering an 18-year period included all medical and court records of 323 children (2.5 months to 3 years) with AHT, confirmed by the authors acting as medical experts. All markers for abuse and forensic written reports were analyzed by using a standardized data collection tool. The usual child care arrangement and the child’s location at the time of injury were noted. The percentage of day care centers found in the study was compared to the expected rate in the French population (19.5%) by using the χ2 test.RESULTS:In 317 AHT cases (98.5%), the assault occurred in a private home (4 in other indoor settings and 1 with missing data). In only 1 case, shaking occurred in a day care center when the nurse was alone with the infant for a few minutes. In 317 cases (98.5%), the usual child care arrangement was by a single adult in charge of 1 or more children.CONCLUSIONS:The fact that AHT is an unusual occurrence in day care centers could help social service agencies make decisions in terms of prevention. Recent government policies regarding stay-at-home orders during a pandemic have given this issue new relevance.

The population of people in police custody is a sentinel niche that is poorly represented in the "usual panels" of public health studies. The aim is to make an overview of their diversion of drugs.A retrospective study based on cases of misuse in a sample of people in custody examined between 2015 and 2016 at the forensic medicine unit of the hospital Hôtel-Dieu-Paris.Of the 5149 medical examinations, 302 were for substance use disorder or drug misuse. In 2016, the number of notifications for misuse of clonazepam increased (n=65); the user population appears to be getting younger (average age=23.5 years) and to be supplied mainly by deal (63%). Regarding opioid substitution treatments, the indicators of abuse and diversion are confirmed, while morphine sulfate stands out with a strong deal (75%), IV injection (62%) and polydrug use, including methadone, cocaine (62%).From our results, national surveys in general population and studies carried out in the context of deprivation of liberty, people in police custody constitute a real barometer of the parallel market for street drugs. Clinical impacts can be major; a better monitoring is needed. For caregivers, it is also a matter of better identification of misuse, substance use disorder for a future orientation of the patient.

Resume Les auteurs rapportent le cas d’un nourrisson de 9 mois retrouve decede quelques heures apres avoir ete mis a la sieste par ses parents. Les analyses toxicologiques ont revele la presence de fentanyl et de norfentanyl dont les concentrations dans le sang cardiaque etaient respectivement de 32,3 et 10,2 ng/mL, dans le contenu gastrique de 362 et 5,9 ng/g et dans la bile de 93,2 et 19,2 ng/mL. En depit des difficultes connues d’interpretation des concentrations post-mortem de fentanyl, il a ete conclu que le deces de l’enfant provenait d’une intoxication aigue au fentanyl. L’enquete a montre que le frere du defunt, âge de 6 ans, soigne pour un cancer, recevait un traitement par fentanyl sous forme de dispositif transdermique. Un patch de fentanyl est concu pour delivrer le principe actif a vitesse lente et constante sur une duree de 72 heures, temps a l’issue duquel environ la moitie du principe actif est encore present : comme la mort de l’enfant resulte d’une impregnation massive par le fentanyl delivre dans un laps de temps court, l’hypothese d’un patch place volontairement ou accidentellement sur la peau de l’enfant n’a pas ete retenue. L’autopsie n’ayant pas revele la presence d’un dispositif transdermique dans le tractus digestif, l’hypothese privilegiee a ete celle d’un patch usage, non correctement elimine par l’entourage, qui aurait ete suce et/ou mâche par le nourrisson, causant rapidement l’intoxication aigue fatale.

Les violences sexuelles sur mineurs, endemiques, ont des consequences redoutables sur le plan somatique et sur le plan psychique. L'examen medical, tres specialise, est toujours utile dans un contexte de violences sexuelles sur un mineur. Cependant, il a des limites et celles-ci doivent etre connues non seulement des medecins mais egalement de l'ensemble des professionnels intervenants : enqueteurs, magistrats et avocats.

International audience; Purpose: Scopolamine, an alkaloid found in certain plants, has become a drug of use for recreational and predatory purposes. We present here the case of an attempted scopolamine-facilitated robbery, via inhalation, with full recovery of the victim. We also performed a review of toxicological findings for scopolamine poisoning cases in available scientific literature. Methods: Whole blood and urine samples were collected 4 h after the assumed poisoning. Concentrations of scopolamine were determined in both samples by a validated and accredited method using liquid chromatography–tandem mass spectrometry. Results: Scopolamine was the only substance found in both whole blood and urine samples, at 7 and 510 ng/mL, respectively. Conclusions: Scopolamine poisoning remains rare, as its half-life is short; blood and urine should be collected as soon as possible for toxicological analysis. This case is, to our knowledge, the first described case of inhaled scopolamine robbery attempt, with quantitative toxicological findings. © 2019, Japanese Association of Forensic Toxicology.

Child sexual abuse is very common. Whether it is a spontaneous revelation, a sign or an evocative symptom, the suspicion of sexual assault on a child requires the doctor to act, regardless of his specialty or mode of exercise. After the interview, the doctor carries out a general somatic examination and writes an initial descriptive medical certificate. Whatever the situation, it is advisable to send the child to hospital for immediate management -gynecological and anal examination, additional examinations, medication prescriptions-. He must explain to the parents the obligatory nature of the hospital summons and its obligation of protection which may lead to an alert to the Republic prosecutor. Physicians must have anticipated these situations and have contact information for their direct child protection contacts.CONDUITE À TENIR FACE À UNE SUSPICION D’ABUS SEXUEL CHEZ L’ENFANT Les cas d’abus sexuel chez l’enfant sont très fréquents. Qu’il s’agisse d’une révélation spontanée, d’un signe ou d’un symptôme évocateur, la suspicion d’agression sexuelle sur un enfant impose au médecin d’agir, quelle que soit sa spécialité ou son mode d’exercice. Après l’entretien, le médecin réalise un examen somatique général et rédige un certificat médical initial descriptif. Quelle que soit la situation, il lui est conseillé d’adresser l’enfant en milieu hospitalier pour la prise en charge immédiate -examen gynécologique et anal, examens complémentaires, prescriptions médicamenteuses-. Il doit expliquer aux parents le caractère obligatoire de la convocation hospitalière et son obligation de protection pouvant aboutir à un signalement au procureur de la République. Le médecin doit avoir anticipé ces situations et disposer des coordonnées de ses interlocuteurs directs de la protection de l’enfance.

Objective To investigate a temporal association between vaccination and subdural hematoma, the main feature of abusive head trauma. Study design From a prospective population-based survey carried out in 1 administrative district in France between January 2015 and April 2017, including all infants between 11 and 52 weeks old who underwent a first cerebral imaging (computerized tomography scan or magnetic resonance imaging), we conducted a nested case-control study. Vaccine exposure was compared between cases (infants with subdural hematoma) and 2-3 paired controls, without subdural hematoma or any other imaging findings compatible with abusive head trauma. Cases and controls were matched on chronological (±7 days) and gestational (≤33 vs >33 weeks) ages, respectively. Vaccination status was collected in the personal national pediatric health booklet. Results Among the 228 prospectively surveyed infants, 28 had subdural hematoma including 22 with abusive head trauma. The mean chronological age at imaging was 5.3 months among the 28 cases and the 62 controls, who did not differ significantly in median time since last vaccination (1.4 vs 1.3 months, P = .62) or frequency of at least 1 vaccination since birth (86% vs 89%; matched-pairs OR 0.77, 95% CI 0.17-3.86) or within 7 days (0.94, 0.08-6.96), 14 days (0.70, 0.12-2.92), or 21 days (0.48, 0.08-1.98) before cerebral imaging. Conclusions We found no significant temporal association between vaccination and subdural hematoma diagnosis, which must continue to be considered a red flag for abusive head trauma and child abuse.

Any pediatrician who works with migrant populations from Africa is likely to encounter girls who have suffered genital mutilation. In the long term, the psychological, sexual, gynecological, and obstetric complications are often highly disabling.The differential diagnosis mainly involves anatomical variants.

The authors provide the reader with some essential points about assessment strategies and recommendations when there is suspicion of abuse: indications leading to hospitalization and complementary examinations, along with general principles for drafting the medical certificate.

Bruises and hematomas are the most well-known signs of abuse. The non-accidental nature of cutaneous lesions can be determined based on ananalysis of the child’s age, the location of the bruise, and the circumstances reported by the family.

Shaken baby syndrome/abusive head trauma is a leading cause of morbidity and mortality in infants. The presence of a diffuse subdural hematoma without evidence of accident is a key diagnostic clue. The hematoma is typically attributed to rupture of the cerebral bridging veins due to violent shaking, with or without impact. Dating the incident, however, remains controversial. The aim of this article is to review the most reliable features used for dating the incident, based on both legal statements by perpetrators and medical documentation. The key points are: 1) The high (yet likely underestimated) frequency of repeated shaking is around 50%, 2) Children do not behave normally immediately after shaking, and the time of onset of even mild symptoms appears to be the best clue for dating the incident and 3) Brain imaging provides strong indicators of “age-different” injuries but the ranges for dating the causal event are wide. The density pattern in a single subdural hematoma location provides no reliable clues for assessing repeated violence. Only the finding of different density in two distant subdural hematomas argues in favor of “age-different” injuries, i.e. repeated violence. MRI is difficult to interpret in terms of dating subdural hemorrhages and must be analyzed in conjunction with CT. Most importantly, all of the child’s previous clinical and radiological data must be carefully studied and correlated to provide accurate information on the date and repetition of the trauma.

Resume Objectifs Une etude prospective a ete menee de juin 2008 a decembre 2010 pour analyser les differences dans le processus de revelation d’agression sexuelle sur les mineurs selon les liens entre les victimes et leur(s) agresseur(s). Methode Les victimes presumees d’agression sexuelle a Paris sont recues sur requisition a l’Unite medico-judiciaire de l’Hotel-Dieu. Un questionnaire comportant des items sur la revelation a ete rempli par les pedopsychiatres du service. Resultats Deux cent vingt mineurs victimes ont ete rencontres. Les devoilements chez les enfants et les adolescents se realisent de maniere beaucoup plus complexe, douloureuse et tardive lorsqu’il s’agit d’agressions sexuelles perpetrees par des agresseurs intrafamiliaux ; il s’agirait alors d’un reel processus. A l’inverse, les revelations dans le cadre extrafamilial se deroulent de maniere plus spontanee et rapide, se caracterisant comme un evenement psychique plus ponctuel. La revelation serait un facteur primordial dans l’apparition ou non de troubles psychologiques ulterieurs. Conclusion La clarification des facteurs facilitant la revelation, notamment selon le type de liens unissant la victime a son (ses) agresseur(s), devrait permettre la mise en place d’actions de prevention pour lutter contre les graves consequences d’un devoilement tardif et douloureux.

Objective To use legal statements by perpetrators to gain new insights into the causative mechanism of classic metaphyseal lesion (CML). The CML, so called “corner fracture,” is considered a highly specific marker for abuse in infants. However, the precise correlation between CMLs and abusive head trauma is still unknown. Study design In this retrospective observational study, we selected 67 cases with at least 1 CML from a 15-year cohort of legally prosecuted child abuse cases. Their clinical, radiologic, and forensic records were analyzed. In 27 cases, the perpetrator confessed to abusing the child and described the events. Potential associations with subdural hematoma and with confession were evaluated using 2 separate binary logistic regression models. Results All 67 infants showed other signs of abuse. Median age was 3.4 months. Over 65% had multiple CMLs. Knees and ankles were predominantly involved (64%). Only CMLs of the shoulder were significantly associated with subdural hematoma (P = .03). Different-age fractures were more common in the nonsubdural hematoma group (P = .01). In the group with confessions, perpetrators admitted inflicting violent indirect skeletal forces (torsion, traction, compression, and forced movements). The most common circumstance was diapering (44%), reported by male perpetrators only (P = .03) followed by dressing/undressing (30%). The violence was habitual in 67% of cases. Conclusions This unique forensic case series shows that CMLs are caused by violent acts inflicted most during physical care of infants. The frequency of habitual violence responsible for CMLs deserves greater attention.

To evaluate the accuracy of abdominal radiography (AXR) for the detection of residual cocaine packets by comparison with computed tomography (CT). Over a 1-year period unenhanced CT was systematically performed in addition to AXR for pre-discharge evaluation of cocaine body packers. AXR and CT were interpreted independently by two radiologists blinded to clinical outcome. Patient and packet characteristics were compared between the groups with residual portage and complete decontamination. Among 138 body packers studied, 14 (10 %) had one residual packet identified on pre-discharge CT. On AXR, at least one reader failed to detect the residual packet in 10 (70 %) of these 14 body packers. The sensitivity and specificity of AXR were 28.6 % (95 % CI: 8.4–58.1) and 100.0 % (95 % CI: 97.0–100.0) for reader 1 and 35.7 % (95 % CI: 12.8–64.9) and 97.6 % (95 % CI: 93.1–99.5) for reader 2. There were no significant patient or packet characteristics predictive of residual portage or AXR false negativity. All positive CT results were confirmed by delayed expulsion or surgical findings, while negative results were confirmed by further surveillance. Given the poor performance of AXR, CT should be systematically performed to ensure safe hospital discharge of cocaine body packers. • Both abdominal radiography and computed tomography can identify gastrointestinal cocaine packets. • Ten per cent of body packers had residual packets despite two packet-free stools. • Seventy per cent of these residual packets were missed on AXR. • No patient or packet characteristics predicted residual packets or AXR false negativity. • CT is necessary to ensure safe medical discharge of body packers.

OBJECTIVES: In cases of assault and battery, the French Penal Code considers some aggravating factors. No data are available on the frequency of aggravating factors. Our main objective was to determine this frequency. A secondary objective was to present the evaluation in several forensic medicine units of the duration of the victims' inability to fulfil their usual daily activities, in days of "Total incapacity to work" (TIW). METHODS: Data were collected from six forensic medicine units on 300 evaluations of assaults survivors: aggravating factors, characteristics of the victims and of the assaults, results of medical examination, and determinants of TIW. RESULTS: Aggravating factors were present in most cases (232 of 300, 77%). Median duration of TIW was 2 days (range: 0-60). Medical evaluation ended in the absence of TIW in 0 to 56% of cases in the 6 units (Chi(2), P Language: fr

SCOPUS: ar.j, info:eu-repo/semantics/published

OBJECTIVE: Confessions are uncommon in abusive head trauma (AHT) cases, and there is debate over whether shaking alone can cause the injuries characteristic of AHT. The objective of this article is to correlate legal statements by perpetrators with medical documentation to offer insights into the mechanism of injury. METHODS: In this retrospective observational study we examined forensic evidence from 112 cases referred for AHT over a 7-year period. We compared 29 cases in which a perpetrator confessed to violence toward the child with 83 cases in which there was no confession. Inclusion criteria were subdural hematoma (SDH) on computed tomography and perpetrator admission of a causal relationship between the violence inflicted and the child's symptoms. Groups were compared by using Student's t test for age and Fisher's exact test for gender, death, fractures, retinal hemorrhages, ecchymoses, symptoms, and SDH patterns. All medical records from birth to diagnosis, imaging studies, and written investigation reports were reviewed. RESULTS: All confessions came from forensic investigations. There was no statistically significant difference between the 2 groups for any of the variables studied. Shaking was described as extremely violent (100%) and was repeated (55%) from 2 to 30 times (mean: 10) because it stopped the infant's crying (62.5%). Impact was uncommon (24%). No correlation was found between repeated shaking and SDH densities. CONCLUSIONS: This unique forensic case series confirms the violence of shaking. The high frequency of habitual AHT is a strong argument for reporting suspected cases to judicial authorities and helps to explain the difficulty in dating the injuries.

Drug-facilitated crime in sexual assault situations remains insufficiently recognized by physicians. In the possible context of an assault and in front of recent neuropsychicological disturbances in a child, such an issue has to be considered. The quality of sampling, the use of ultra-sensitive and specific toxicologic methods and a clinical-biological collaboration allow to recognize this form of delinquency whose consequences are both medical and legal.

Introduction Peu de publications francaises s’interessent aux lesions genitales des mineures victimes d’infractions a caractere sexuel. Objectif Analyser les caracteristiques de ces lesions genitales (nature et prevalence). Materiels et methodes Tous les mineurs examines pour suspicion d’infraction a caractere sexuel sur requisition judiciaire aux urgences medico-judiciaires de Paris entre le 01/06/08 et le 31/05/11 ont ete inclus de facon prospective. Les donnees ont ete recueillies de facon standardisee. Resultats Sur les 484 mineurs inclus, 80,4 % etaient des filles. L’âge moyen etait de 10,8 ans [0,4–17]. Les faits declares etaient majoritairement des penetrations (59 %) et des attouchements (19 %). Dans 84,9 % des cas, aucune lesion traumatique specifique n’a ete mise en evidence. Les lesions traumatiques hymenales etaient plus frequentes en cas de fait unique (p = 0,0005). Les fissures anales etaient plus frequentes lorsque l’examen etait realise plus de 24 heures apres les faits allegues (p = 0,024). Conclusions Les lesions genitales specifiques sont rarement retrouvees dans les examens de mineures victimes d’infractions a caractere sexuel. Si un examen clinique minutieux a la recherche de lesions genitales est indispensable, il n’est qu’un element de la preuve judiciaire.

Any general practitioner might have to examine and care for a sexual assault victim in their professional practice. Taking time to listen to the victim's story is essential to direct the examination and sample collection. The general physical examination screens for physical injuries. Perineal examination is specialized, and should be performed within a very short period of time in the event of a recent assault with sexual penetration. The purpose of further examination is to collect evidence and identify the victim's sexually transmitted disease status to screen for any seroconversion during follow-up. Preventive measures should be considered on an individual basis: contragestion, triple antiretroviral therapy, immunoglobulins and hepatitis B immunization. Lastly, referrals to social or psychotherapeutic services and/or associations are extremely helpful to the victim.

In cases of assault and battery, the French Penal Code considers some aggravating factors. No data are available on the frequency of aggravating factors. Our main objective was to determine this frequency. A secondary objective was to present the evaluation in several forensic medicine units of the duration of the victims' inability to fulfil their usual daily activities, in days of "Total incapacity to work" (TIW).Data were collected from six forensic medicine units on 300 evaluations of assaults survivors: aggravating factors, characteristics of the victims and of the assaults, results of medical examination, and determinants of TIW.Aggravating factors were present in most cases (232 of 300, 77%). Median duration of TIW was 2 days (range: 0-60). Medical evaluation ended in the absence of TIW in 0 to 56% of cases in the 6 units (Chi(2), P0.0001). Forensic physicians considered that they had not evaluated the victims' mental state in 63 of 300 cases (21%). This rate varied significantly from one unit to another (P0.0001). Determinants of TIW were primarily traumatic injuries in 45% of cases and functional impairment in 55%. Such proportions varied from one unit to another (P=0.01). Mental state impairment was the main determinant of TIW in 0 to 23% of cases (P=0.009).The present study documented the high frequency of aggravating factors and the heterogeneity of forensic evaluation in cases of assault and battery. Identifying determinants of TIW in everyday practice can participate in the development of national guidelines.

Child abuse is a controversial problem of special concern. Recent reports have focused on the broad variability of reporting to child protection services. Radiologists play a key role in the early diagnosis and imaging of suspected inflicted injury. Imaging must be performed and then interpreted with rigour.The aims of this review are: To review the recent recommended guidelines for imaging in cases of suspicion of abuse. These include a highly detailed complete skeletal survey with centered views, whilst brain CT and/or MRI are mandatory in children younger than 2 years. The use of abdominal imaging is debatable if the child has no symptoms. All siblings younger than 2 years should be assessed in the same way while the diagnosis of abuse is investigated. Body MRI is an interesting modality that remains a "work-in-progress". To highlight that dating of both brain and skeletal injuries is imprecise. The main point is, however, to determine if the pattern is of "age-different" lesions. This not only provides a strong argument for the diagnosis of abuse, but also indicates repetitive violence with a high risk for further injury and death. To remember that the medical perspective is to protect the child. Thus, radiologists must communicate clearly the suspicion of abuse and the degree of certainty to clinicians to aid reporting or hospitalization.