Defendants accused of inflicting fatal
abdominal injuries to children occasionally raise the defense that the
injuries were caused by
cardiopulmonary resuscitation (
CPR). The purpose of this study is to answer the question: Does closed chest
CPR result in fatal blunt
abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt
abdominal injuries in children 10 years and younger 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 natural causes during the same time period in Broward County who had
CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal
trauma (control group 2). Children with life-threatening
head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether
CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal
abdominal injuries were reviewed. Twenty-four (73%) of the homicides received
CPR. There was no difference in the nature and severity of
injuries between the 24 children who received
CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had
CPR. No traumatic
abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal
trauma related to
CPR. No cases of nonvehicular accidental blunt abdominal
trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal
injuries. The likelihood of
CPR-related primary abdominal
trauma in child homicides is very low.