Are abusive fractures in young children becoming less common?

Leventhal, John M.; Larson, Ilse; Abdoo, Denise; Singaracharlu, Sujatha; Takizawa, Carolina; Miller, Catherine; Goodman, T. Rob; Schwartz, Deena; Grasso, Susanne; Ellingson, Katherine

doi:10.1016/j.chiabu.2006.07.004

Cited by 41 publications

(40 citation statements)

References 8 publications

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“…Approximately 80% of all fractures caused by child abuse occur in children younger than 18 months, 12 and approximately one-quarter of fractures in children younger than 1 year are caused by child abuse. 1,9,[13][14][15] Physical abuse is more likely to be the cause of femoral fractures and humeral fractures in children who are not yet walking compared with children who are ambulatory, [15][16][17][18] and the percentage of fractures caused by abuse declines sharply after the child begins to walk. 9,19,20 Fracture Specificity for Abuse…”

Section: Child's Age and Developmentmentioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

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252

162

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Fractures are common injuries caused by child abuse. Although the consequences of failing to diagnose an abusive injury in a child can be grave, incorrectly diagnosing child abuse in a child whose fractures have another etiology can be distressing for a family. The aim of this report is to review recent advances in the understanding of fracture specificity, the mechanism of fractures, and other medical diseases that predispose to fractures in infants and children. This clinical report will aid physicians in developing an evidence-based differential diagnosis and performing the appropriate evaluation when assessing a child with fractures. Pediatrics 2014;133:e477-e489 INTRODUCTIONFractures are the second most common injury caused by child physical abuse; bruises are the most common injury. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 2-4 Physical abuse may not be considered in the physician' s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted. 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family. To identify child abuse as the cause of fractures, the physician must take into consideration the history, the age of the child, the location and type of fracture, the mechanism that causes the particular type of fracture, and the presence of other injuries while also considering other possible causes. DIFFERENTIAL DIAGNOSIS OF FRACTURES Trauma: Child Abuse Versus Noninflicted InjuriesFractures are a common childhood injury and account for between 8% and 12% of all pediatric injuries. [6][7][8] In infants and toddlers, physical FROM THE AMERICAN ACADEMY OF PEDIATRICSGuidance for the Clinician in Rendering Pediatric Care by guest on May 11, 2018 http://pediatrics.aappublications.org/ Downloaded from abuse is the cause of 12% to 20% of fractures. 9 Although unintentional fractures are much more common than fractures caused by child abuse, the physician needs to remain aware of the possibility of inflicted injury. Although some fracture types are highly suggestive of physical abuse, no pattern can exclude child abuse. 10,11 Specifically, it is important to recognize that any fracture, even fractures that are commonly noninflicted injuries, can be caused by child abuse. Certain details that can help the physician determine whether a fracture was caused by abuse rather than unintentional injury include the hist...

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Section: Child's Age and Developmentmentioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

Self Cite

252

162

View full text Add to dashboard Cite

show abstract

“…[4][5][6] Fractures are one of the most common injuries for which victims of abuse seek medical care, but fractures are also a common accidental injury. [7][8][9] Distinguishing cases of abusive fractures from accidental fractures can be difficult. 9,10 Nevertheless, failure of providers to diagnose abuse can result in children suffering morbidity and mortality from additional undiagnosed injuries as well as on-going abuse.…”

Section: Discussionmentioning

confidence: 99%

Development of Guidelines for Skeletal Survey in Young Children With Fractures

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Rates of performing skeletal survey (SS) for young children presenting with fractures and at risk for abuse vary substantially across providers, with disparities associated with patients' characteristics. Lack of consensus regarding indications for SS also contributes to this variation. WHAT THIS STUDY ADDS:The results of this study provide a set of explicit consensus guidelines, based on the literature and on the knowledge of experts from several medical specialties, for identifying children with fractures who should undergo an initial SS.abstract OBJECTIVE: To develop guidelines for performing initial skeletal survey (SS) in children ,24 months old with fractures, based on available evidence and collective judgment of experts from diverse pediatric specialties. METHODS:Following the Rand/UCLA Method, a multispecialty panel of 13 experts applied evidence from a literature review combined with their own expertise in rating the appropriateness of performing an SS for 525 clinical scenarios involving fractures in children ,24 months old. After discussion on the initial ratings, panelists rerated SS appropriateness for 240 revised scenarios and deemed that SSs were appropriate in 191 scenarios. The panelists then assessed in which of those 191 scenarios SSs were not only appropriate, but also necessary. RESULTS:Panelists agreed that SS is "appropriate" for 191 (80%) of 240 scenarios rated and "necessary" for 175 (92%) of the appropriate scenarios. Skeletal survey is necessary if a fracture is attributed to abuse, domestic violence, or being hit by a toy. With few exceptions, SS is necessary in children without a history of trauma. In children ,12 months old, SS is necessary regardless of the fracture type or reported history, with rare exceptions. In children 12 to 23 months old, the necessity of obtaining SS is dependent on fracture type. CONCLUSIONS:A multispecialty panel reached agreement on multiple clinical scenarios for which initial SS is indicated in young children with fractures, allowing for synthesis of clinical guidelines with the potential to decrease disparities in care and increase detection of abuse. Pediatrics 2014;134:45-53

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“…The risk of NAT is inversely related to the age of the child with most victims being younger than 2 years of age [1,3,25,43]. There are mixed results regarding whether a particular race is at greater risk for experiencing NAT [9,[24][25][26]28]. Of note, black children have a greater risk of mortality from NAT [16,34].…”

Section: Risk Factorsmentioning

confidence: 99%

The Epidemiology of Nonaccidental Trauma in Children

Mulpuri

Slobogean

Tredwell

2011

Clinical Orthopaedics &Amp; Related Research

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Background Abuse of children is abhorrent in Western society and, yet, is not uncommon. Nonaccidental trauma (NAT) is the result of a complex sociopathology. Not all of the causative factors of NAT are known, many are incompletely described, not all function in each case, and many are secondary to preexisting pathology in other areas. Questions/purposes We therefore addressed the following questions in this review: (1) Conclusions It is important to consider child, family, and societal factors when confronted with suspicions of child abuse. Our review demonstrates the currently limited information on the true incidence of NAT. To determine a much more accurate incidence of NAT, there needs to be a population-based surveillance program conducted through primary care providers.

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Are abusive fractures in young children becoming less common?

Cited by 41 publications

References 8 publications

Evaluating Children With Fractures for Child Physical Abuse

Evaluating Children With Fractures for Child Physical Abuse

Development of Guidelines for Skeletal Survey in Young Children With Fractures

The Epidemiology of Nonaccidental Trauma in Children

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