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Identifying non-accidental fractures in children aged <2 years.

Leaman LA, Hennrikus WL, Bresnahan JJ - J Child Orthop (2016)

Bottom Line: Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1-2 years were reported as NAT (p < 0.001).Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year.Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, Lancaster General Health, Lancaster, PA, USA.

ABSTRACT

Purpose: Fractures are the second most common presentation of child abuse following soft-tissue bruising and burns. It is often difficult to determine potential abuse in a child presenting with a non-rib fracture(s) and without soft-tissue injuries.

Methods: One hundred and fifteen consecutive patients aged ≤2 years who presented with a fracture between January 2010 and June 2012 to our emergency department (ED) or pediatric fracture clinic were retrospectively analyzed. Statistical analyses were carried out for non-accidental fractures based on age (<1 year vs 1-2 years), location of presentation (ED vs pediatric fracture clinic), type of long bone fracture, number of fractures, and patient demographics.

Results: Fractures in 19 of 115 (17 %) patients were reported as non-accidental trauma (NAT). Eighty (70 %) of the 115 patients first reported to the ED. Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1-2 years were reported as NAT (p < 0.001). Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year. Eight of 11 (73 %) reported femoral fractures were transverse fractures. Corner fractures (12) only occurred in children aged <1 year and never occurred in isolation; all of them were reported as NAT. Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT.

Conclusions: Age less than 1 year, multiple fractures, corner fractures, transverse fractures, and covered by Medicaid were the most common factors associated with reporting of NAT.

No MeSH data available.


Related in: MedlinePlus

Overall distribution of fractures in relation to age. Thirty-two percent of those aged <1 year who presented with fractures were reported as NAT as opposed to only 5 % of those aged 1–2 years
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Fig1: Overall distribution of fractures in relation to age. Thirty-two percent of those aged <1 year who presented with fractures were reported as NAT as opposed to only 5 % of those aged 1–2 years

Mentions: Nineteen of 115 patients (17 %) were reported as abuse and 96 (83 %) were considered accidental injuries. Sixteen of 50 (32 %) children aged <1 year with fractures were reported as abuse, while three of 65 (5 %) children aged 1–2 years with fractures were reported as abuse (p < 0.001) (Fig. 1). Ten percent of fractures in males and 23 % of fractures in females (p = 0.059) were reported for abuse (Table 1).Fig. 1


Identifying non-accidental fractures in children aged <2 years.

Leaman LA, Hennrikus WL, Bresnahan JJ - J Child Orthop (2016)

Overall distribution of fractures in relation to age. Thirty-two percent of those aged <1 year who presented with fractures were reported as NAT as opposed to only 5 % of those aged 1–2 years
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940250&req=5

Fig1: Overall distribution of fractures in relation to age. Thirty-two percent of those aged <1 year who presented with fractures were reported as NAT as opposed to only 5 % of those aged 1–2 years
Mentions: Nineteen of 115 patients (17 %) were reported as abuse and 96 (83 %) were considered accidental injuries. Sixteen of 50 (32 %) children aged <1 year with fractures were reported as abuse, while three of 65 (5 %) children aged 1–2 years with fractures were reported as abuse (p < 0.001) (Fig. 1). Ten percent of fractures in males and 23 % of fractures in females (p = 0.059) were reported for abuse (Table 1).Fig. 1

Bottom Line: Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1-2 years were reported as NAT (p < 0.001).Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year.Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, Lancaster General Health, Lancaster, PA, USA.

ABSTRACT

Purpose: Fractures are the second most common presentation of child abuse following soft-tissue bruising and burns. It is often difficult to determine potential abuse in a child presenting with a non-rib fracture(s) and without soft-tissue injuries.

Methods: One hundred and fifteen consecutive patients aged ≤2 years who presented with a fracture between January 2010 and June 2012 to our emergency department (ED) or pediatric fracture clinic were retrospectively analyzed. Statistical analyses were carried out for non-accidental fractures based on age (<1 year vs 1-2 years), location of presentation (ED vs pediatric fracture clinic), type of long bone fracture, number of fractures, and patient demographics.

Results: Fractures in 19 of 115 (17 %) patients were reported as non-accidental trauma (NAT). Eighty (70 %) of the 115 patients first reported to the ED. Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1-2 years were reported as NAT (p < 0.001). Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year. Eight of 11 (73 %) reported femoral fractures were transverse fractures. Corner fractures (12) only occurred in children aged <1 year and never occurred in isolation; all of them were reported as NAT. Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT.

Conclusions: Age less than 1 year, multiple fractures, corner fractures, transverse fractures, and covered by Medicaid were the most common factors associated with reporting of NAT.

No MeSH data available.


Related in: MedlinePlus