Identifying non-accidental fractures in children aged &lt;2 years

Leaman, Laura; Hennrikus, William L.; Bresnahan, James J.

doi:10.1007/s11832-016-0755-3

Cited by 27 publications

(27 citation statements)

References 36 publications

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“…While some studies have suggested that NAT may be more common in males, others found that the rate of abuse was higher in African American children. Neither was a significant factor in this study [ 1 , 4 – 7 ]. We do concur with other studies that NAT most often occurs in children under the age of 2 [ 4 , 5 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center

Goldman

Burjonrappa

2020

International Journal of Pediatrics

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Introduction. Pediatric nonaccidental trauma (NAT) is difficult to diagnose. Several isolated injuries in NAT could happen in the setting of accidental trauma (AT), and having a high index of suspicion is important to correctly identify abuse. NAT has a significant mortality rate if the sentinel event is not adequately diagnosed, and the infant is not separated from the perpetrator. Level 1 pediatric trauma centers (PTC) see a significant number of NAT. We evaluated the injury patterns of NAT admissions at our level 1 PTC. Methods. Retrospective analysis of all cases of NAT for children under the age of two admitted at an ACS level 1 pediatric trauma center between the years of 2016 and 2018. Charts were queried for demographic data, injury patterns, mortality, and disposition. Correlation between disposition status and injury patterns was performed. The Fisher Exact test and student t -test were used to study the significance of differences in categorical and continuous data, respectively. Results. 32/91 (35%) trauma patients under the age of two years were diagnosed as NAT in the three-year study period. 21/32 (39%) male and 11/26 (42%) female admissions were confirmed NAT ( p = NS ). 20 were under 1 year of age, and 12 were aged between 1 and 2 years ( p = NS ). 13 (41%) were Caucasian, 6 (19%) were Hispanic/Latino, 11 (34%) were Black, and 2(6%) were of unknown ethnicity ( p = NS ). Facial, torso, lower extremity, retinal, and internal organ injury were significantly more common with NAT. Medicaid coverage was noted in 31/32 (97%) NAT patients. 20/32 (62.5%) patients were legally displaced as a result of the NAT. Conclusion. 1/3rd of all admissions at a pediatric level 1 trauma center were identified as NAT. A high index of suspicion is necessary to not miss NAT, as injury patterns are variable. Nearly 1/3rd of all victims go back to the same environment where they sustained NAT increasing their susceptibility to future NAT.

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Section: Discussionmentioning

confidence: 99%

Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center

Goldman

Burjonrappa

2020

International Journal of Pediatrics

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“…[7] Further, in a recent study, Leaman et al . [19] analyzed the data of 16 confirmed cases of abuse in children aged <2 years and found 13 (81%) children had multiple fractures. Nonetheless, a recent study from Singapore found multiple bone fractures to be rare, as it was reported in only 8.4% of the studied children.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, in terms of fracture patterns, Leaman et al . [19] also found transverse fractures to be more common, with 8 of 11 femur fractures having the transverse fracture pattern. However, it should be noted that patterns do not significantly help guide a physician toward the suspicion of abuse,[13151617182122] likely because common fracture patterns are likely to differ.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of nonaccidental fractures in abused children in Riyadh, Saudi Arabia

Jawadi

Benmeakel

Alkathiri

et al. 2019

Saudi J Med Med Sci

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Background:Child abuse is a major problem globally. Nonaccidental fractures are the second most common injury among physically abused children; however, there is a lack of studies describing the characteristics of nonaccidental fractures in Saudi Arabia.Objectives:The objective of this study was to determine the characteristics of nonaccidental fractures among abused children in Riyadh, Saudi Arabia, using radiography.Materials and Methods:This retrospective study analyzed the data and radiographs of all nonaccidental fracture cases in children (aged ≤14 years) registered in the National Family Safety Program Registry at King Abdulaziz Medical City, Riyadh, between 2009 and 2015.Results:A total of 1512 cases of child abuse were found in the National Family Safety Program Registry database from Riyadh city. From these, 103 fractures were identified; however, radiographs were available for only 70 fractures from 56 children. Of these, 33 (59%) were boys, and 25 (45%) were aged 1–5 years. In terms of the type of abuse, neglect was more common than physical abuse (52% vs. 45%). History of injury was identified in 75% (42) of the cases, of which fall accounted for about 55% (23). Nearly 79% of children presented with a single bone fracture, while 21% had multiple bone fractures. The most common sites of fractures were skull (40%), upper limbs (31%) and lower limbs (29%). The most common fracture pattern was transverse fractures (48%), and it was mainly diagnosed in skull fractures (51%).Conclusions:This study found that in Riyadh, Saudi Arabia, neglect is the most common cause of nonaccidental fractures, abusive head trauma is the most commonly associated injury and transverse fracture is the primary pattern of fracture in abused children. Notably, as most children experienced a single-bone fracture, the authors recommend clinicians to lower their threshold of considering abuse even in cases with an isolated fracture.

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“…12 Metaphyseal corner fractures, although highly specific for child abuse, may occur infrequently in the ambulatory child. 13 Repeat skeletal surveys may be performed in 2 weeks for high-risk cases. Bone scintigraphy may be used to complement radiographs when symptoms are poorly localized, particularly in nonverbal and/or neurodevelopmentally delayed children.…”

Section: Nonaccidental Traumamentioning

confidence: 99%

The Acutely Limping Preschool and School-Age Child: An Imaging Perspective

Chaturvedi

Cain

Rupasov

2018

Semin Musculoskelet Radiol

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Acute limp in a child presents a diagnostic conundrum and can result from a variety of causes. The underlying etiology is often referable to the hip, but the spine, abdomen, pelvis, or knee can be alternatively implicated. An adequate clinical history and satisfactory physical examination are often difficult in younger children. Consequently, there is disproportionate reliance on imaging to arrive at the correct diagnosis. The potential for rapid clinical deterioration and long-term sequelae is a risk with some of the conditions presenting with acute hip (septic hip, osteomyelitis). This review article describes the imaging appearance of common etiologies for acute limp in the ambulatory preschool (1-5 years) and school-age child (5-12 years). The ultimate goal is to familiarize the interpreting radiologist with the imaging appearance of specific clinical entities that lead to acute limp while providing a readily accessible resource on how to image the patient most appropriately and judiciously.

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Identifying non-accidental fractures in children aged <2 years

Cited by 27 publications

References 36 publications

Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center

Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center

Characteristics of nonaccidental fractures in abused children in Riyadh, Saudi Arabia

The Acutely Limping Preschool and School-Age Child: An Imaging Perspective

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