Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children

Defendants accused of inflicting fatal abdominal injuries to children occas ionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: D oes closed chest CPR result in fatal blunt abdominal injuries that can be m istaken for homicidal assault? To that end, a retrospective study was condu cted of all homicidal blunt abdominal injuries in children 10 years and you nger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of na tural causes during the same time period in Broward County who had CPR (con trol group 1) and to children who died of nonvehicular accidental blunt abd ominal trauma (control group 2). Children with life-threatening head injuri es were excluded. Medical examiner records, autopsy reports, documenting ph otographs, and clinical records were reviewed. The data analyzed included s ubject demographics, whether CPR was performed and by whom, and autopsy fin dings. Thirty-three child homicides with fatal abdominal injuries were reviewed. T wenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CP R and the 9 who did not. Three hundred and twenty-four cases of pediatric n atural deaths were reviewed, all of which had CPR. No traumatic abdominal i njuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal tra uma related to CPR. No cases of nonvehicular accidental blunt abdominal tra uma were identified during the 17-year period, although there were nonvehic ular accidental fatalities due to extraabdominal. injuries. The likelihood of CPR-related primary abdominal trauma in child homicides i s very low.