American Board of Medicolegal Death Investigators (ABMDI) Practice Exam

Which injury is most indicative of child battering for an investigator?

1. A fracture of long bones

2. Injuries inconsistent with the explained mode of injury

3. A history of a fall

4. Thermal burns to the body

The correct answer is: Injuries inconsistent with the explained mode of injury

The presence of injuries that are inconsistent with the explained mode of injury is particularly telling in cases of child battering. When a caregiver provides an explanation for a child’s injuries, and that explanation does not align with the severity, type, or pattern of the injuries observed, it raises significant red flags. This discrepancy suggests that the injuries may not have occurred as described, which is often indicative of abuse rather than accidental harm. Investigators look for such inconsistencies as part of a broader assessment of the child’s environment and the dynamics of the caregiver-child relationship. For instance, if a child sustains serious injuries but the caregiver claims they occurred from a benign incident, such as a minor fall, that contradiction leads investigators to suspect potential maltreatment. While other options might indicate abuse to varying degrees, they may not be as unequivocally diagnostic as the presence of injuries that do not correspond to the explanation given. A fracture of long bones and thermal burns can indeed suggest abuse, but they also can occur through accidents depending on the circumstances. A history of a fall can be investigated further; however, if the injuries do not support this account, it makes a much stronger case for child battering.