Can we increase detection? A nationwide analysis of age-related fractures in child abuse

Shedding Light on Child Physical Abuse and its Ramifications: A Review

“…According to the 4th National Incidence Study of Child Abuse and Neglect, a surveillance report published by the U.S. congress every ten years, nearly 1.3 million children are maltreated every year [34]. In the U.S. 35% of children presented with extremity fractures and 24% with skull fractures [35,36].…”

“…Children who suff ered fractures caused by physical abuse have a signifi cantly higher risk of mortality than those children whose fractures were caused by accidental or pathologic etiologies [37]. It is, therefore, imperative that we improve detection of fracture patterns, as some injuries [i.e., clavicular and long bone diaphyseal fractures] should raise a red fl ag regarding parental abuse [34]. Quiroz HJ, et al [34] While multiple fractures in children often increase suspicion that child abuse was committed, it should also be known by healthcare professionals that underlying genetic conditions such as osteogenesis imperfecta and defi ciencies in vitamin D and copper can also result in multiple fractures in children, and those would not be the result of child abuse [38].…”

“…It is, therefore, imperative that we improve detection of fracture patterns, as some injuries [i.e., clavicular and long bone diaphyseal fractures] should raise a red fl ag regarding parental abuse [34]. Quiroz HJ, et al [34] While multiple fractures in children often increase suspicion that child abuse was committed, it should also be known by healthcare professionals that underlying genetic conditions such as osteogenesis imperfecta and defi ciencies in vitamin D and copper can also result in multiple fractures in children, and those would not be the result of child abuse [38]. Quiroz HJ, et al [34], thus highlighted the need for careful determination of the mechanism of injury and using other screening tools when assessing a child with a potential for multiple fractures.…”

“…Quiroz HJ, et al [34] While multiple fractures in children often increase suspicion that child abuse was committed, it should also be known by healthcare professionals that underlying genetic conditions such as osteogenesis imperfecta and defi ciencies in vitamin D and copper can also result in multiple fractures in children, and those would not be the result of child abuse [38]. Quiroz HJ, et al [34], thus highlighted the need for careful determination of the mechanism of injury and using other screening tools when assessing a child with a potential for multiple fractures. Additionally, medical workup of potential pathologic causes for fractures in children is also recommended [38].…”

“…Rib fractures have the highest specifi city of any fracture for abusive etiology and are often linked to infants who have Abusive Head Trauma (AHT) as well, suggesting the "shaking" mechanism of injury [42,43]. Quiroz HJ, et al [34] found a statistically signifi cant increase in rib fractures in infants when compared to any other age group, suggesting that shaking is a common physical abuse of infants [44].…”