The risk of child abuse in infants and toddlers with lower extremity injuries
Section snippets
Methods
An Institutional Review Board–approved retrospective review of hospital-based trauma registry data was conducted to identify children with lower extremity injuries admitted to an American College of Surgeons–verified level I pediatric trauma center for 5 years (from 1998 through 2002 inclusive). After preliminary review of the population for age, cause of injury, and diagnoses, the group was further divided into 2 age groups for comparison: children younger than 18 months and children 18 months
Results
The study group consisted of 5497 patients admitted for treatment of injury during the time frame of the study. In the study group, 4942 (90%) children were 18 months or older and 555 (10%) were younger than 18 months old. The incidence of child abuse was 104 (2%) of 4942 children 18 months or older and 175 (32%) of 555 children younger than 18 months (OR, 21.4 ± 2.9, P < .001).
There were 1252 patients with lower extremity injuries in the entire study group. Sixty-six of these patients were
Discussion
The importance of recognizing abusive head trauma, which may masquerade as a variety of illnesses, has been emphasized by numerous studies [3], [4], [5]. However, when a child presents for treatment of lower extremity trauma, the diagnosis of abusive injury might seem to be more straightforward, as only rare medical conditions mimic lower extremity trauma [6]. Nevertheless, terms such as “toddler's fracture,” which is “typically a hairline, oblique fracture of the shaft of the tibia”[7], and
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Cited by (56)
Can we increase detection? A nationwide analysis of age-related fractures in child abuse
2021, Journal of Pediatric SurgeryTrauma
2019, A Practice of Anesthesia for Infants and ChildrenAbusive fracture incidence over three decades at a level 1 pediatric trauma center
2018, Child Abuse and NeglectTrauma
2018, A Practice of Anesthesia for Infants and ChildrenFemur fracture biomechanics and morphology associated with torsional and bending loading conditions in an in vitro immature porcine model
2017, Journal of Forensic and Legal MedicineCitation Excerpt :Fractures are a common presentation of physical child abuse, occurring in nearly a third of child abuse cases.1–3 Femur fractures are particularly concerning, accounting for up to 50% of all fractures in child abuse.4–10 In young, non-ambulating children, fractures are strong indicators of abuse; studies have reported between 30% and 50% of femur fractures in non-ambulating children or those in early ambulating stages are due to abuse.11–13
Prevalence of Retinal Hemorrhages in Infants Presenting with Isolated Long Bone Fractures and Evaluation for Abuse
2016, Journal of Emergency MedicineCitation Excerpt :In addition, this study did not collect data on whether the treating providers determined the fractures to be from abuse. The likelihood that many of the children were abused was high, as it has been reported 35–75% of femur fractures, 54–100% of humerus fractures, and 40–96% of tibia/fibula fractures are concerning for abuse in children < 12 to 18 months (25–32). Finally, despite a 10-year time period, the number of subjects in the final analysis is relatively small.