Novel Classification System of Rib Fractures Observed in Infants

Derrick

et al. 2014

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The literature pertaining to pediatric skull fracture is primarily clinically based and thus motivated by the need for effective assessment of both fracture characteristics (type, frequency, location, and mechanics) and context (severity of injury, associated soft tissue damage, and prognosis). From a strictly descriptive standpoint, these schemas employ overlapping levels of detail that confound the nonclinical description of fractures in the forensic context. For this reason, application of these schemas in the forensic anthropological interpretation of skull fractures is inappropriate. We argue that forensic anthropological interpretation of skull fractures requires a standard classification system that reflects fracture morphology alone, and we suggest a three-stepped classification system that conveys increasing detail with each additional step. A retrospective application of the method to a sample of 31 children aged 1 month to 2 years demonstrated its efficacy in the description of pediatric skull fractures.

Section: Discussionmentioning

confidence: 99%

Standardized Descriptive Method for the Anthropological Evaluation of Pediatric Skull Fractures

Wiersema

Derrick

et al. 2014

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“…A rib scheme based on bony anatomic landmarks was developed to describe the location and extent of rib fractures observed during the study period . This study refines the previously developed scheme focusing on the paravertebral region and applies the modified scheme to the injuries found in the 12‐month prospective study sample.…”

Section: Methodsmentioning

confidence: 99%

“…To ensure detection of paravertebral rib fractures, a protocol for thorough rib examination during a postmortem examination was previously developed . This protocol was utilized as part of a prospective evaluation of infant fatalities, during which numerous costovertebral fractures were observed.…”

mentioning

confidence: 99%

A Proposed Scheme for Classifying Pediatric Rib Head Fractures Using Case Examples

Pinto

Derrick

et al. 2014

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Pediatric rib head fractures are typically described as "posterior" or "costovertebral," terms lacking specificity. To resolve this issue, a scheme was developed to describe the location of rib head fractures observed in a pediatric forensic population. The scheme uses three anatomical landmarks, terminus (tip), tubercle, and costovertebral articular surface to divide the rib head into two subregions, costovertebral and costotransverse. Examples of five cases of infants with rib head fractures are presented using this scheme. Forty-eight rib head fractures were observed in these infants with the following frequencies: 56% (three infants) at the terminus; 21% (three infants) in the costovertebral subregion; 21% (one infant) at the costovertebral articular facet; and 2% (one infant) in the costotransverse subregion. Due to the small number of cases assessed, statistical analyses could not be performed; however, the data demonstrate the variation in distribution of pediatric rib head fractures.

“…All infant deaths investigated by HCIFS were included in this study. The study design is described in more detail along with the findings in Love et al (24) and Pinto et al (25).…”

Section: The Infant Injury Database (Iid)mentioning

confidence: 99%

“…The study design is described in more detail along with the findings in Love et al. and Pinto et al. .…”

Section: The Infant Injury Database (Iid)mentioning

confidence: 99%

The Infant Injury Database: A Tool for the Study of Injury Patterns in Medicolegal Investigations of Child Abuse

Martinez

Pinto

et al. 2019

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In 2012, the Harris County Institute of Forensic Sciences began prospectively collecting injury data from pediatric autopsies. These data and associated case information from 635 pediatric cases are archived in the Infant Injury Database (IID). This paper introduces the IID to the forensic community and demonstrates its potential utility for child abuse and infant fatality investigations. The database is intended to be a source of evidence‐based research for coroners/medical examiners and clinicians in the recognition and diagnosis of child abuse. RR estimates were employed to quantify the relationship between individual autopsy findings to trauma‐related and nontrauma‐related causes of death. For example, unsurprisingly, the RR of trauma cases with multiple injury types is significantly greater than other causes of death, but the RR results provide a quantitative representation of the relationship. ROC curve modeling of the presence/absence of various injury types performed well at discriminating trauma from other causes of death (AUC = 0.96).