Cause and Clinical Characteristics of Rib Fractures in Infants

Bulloch, Blake; Schubert, Charles J.; Brophy, Patrick D.; Johnson, Neil; Reed, Martin H.; Shapiro, Robert A.

doi:10.1542/peds.105.4.e48

Cited by 185 publications

(72 citation statements)

References 12 publications

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“…For example, in studies looking at fractures in children between birth and 3 years of age, the prevalence of abuse in injured children ranged from 23% to as high as 83% for children under 2 years with rib fractures. [67][68][69][70] The prevalence of abuse in young children with head injury was also high, ranging from 14% to 70% depending on the age of the child, the type and severity of head injury and the measurement of physical abuse. [71][72][73][74][75][76] …”

Section: Review Resultsmentioning

confidence: 99%

“…All of the included studies were based on specific injury groups that would be classified post hoc, after investigation, and which are therefore likely to be based on highly selected populations, at higher risk of abuse than the average injured child attending A&E. 65,70,87 The included studies suggest some consistency in the risk of abuse for burns 80,81 but not for other types of injury.…”

Section: Review Resultsmentioning

confidence: 99%

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Performance of screening tests for child physical abuse in accident and emergency departments

Woodman¹,

Pitt²,

Wentz³

et al. 2008

Health Technol Assess

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How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) Programme, part of the National Institute for HealthResearch (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in t...

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Section: Review Resultsmentioning

confidence: 99%

Section: Review Resultsmentioning

confidence: 99%

Performance of screening tests for child physical abuse in accident and emergency departments

Woodman¹,

Pitt²,

Wentz³

et al. 2008

Health Technol Assess

View full text Add to dashboard Cite

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“…There are few reports regarding the sites of fracture in children with rickets, but in case reports a variety of sites were involved, including clavicle, radius/ulna, lateral rib and femur [55][56][57][58][59][60]. Only one study has retrospectively evaluated fracture patterns in children with rickets.…”

Section: Fracture In Children With Vitamin D Deficiency Ricketsmentioning

confidence: 99%

Vitamin D and skeletal health in infancy and childhood

et al. 2014

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During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High quality randomised trials are now required to confirm this benefit.

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“…22 Other less common causes of rib fractures in infants include significant trauma sustained during childbirth or a motor vehicle crash as well as minor trauma in infants who have increased bone fragility. [23][24][25] Cardiopulmonary resuscitation (CPR) has been proposed as a cause of rib fractures, but conventional CPR with 2 fingers of 1 hand rarely causes fractures in children. 26,27 Recent recommendations that CPR be performed using 2 hands encircling the rib cage have raised concerns that this technique might cause rib fractures.…”

mentioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

251

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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Cause and Clinical Characteristics of Rib Fractures in Infants

Abstract: Most rib fractures in infants are caused by child abuse. Although much less common, rib fractures can also occur after serious accidental injuries, birth trauma, or secondary to bone fragility. A thorough clinical and imaging evaluation is mandatory.

Cited by 185 publications

References 12 publications

Performance of screening tests for child physical abuse in accident and emergency departments

Performance of screening tests for child physical abuse in accident and emergency departments

Vitamin D and skeletal health in infancy and childhood

Evaluating Children With Fractures for Child Physical Abuse

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