Premium
Identifying Maltreatment in Infants and Young Children Presenting With Fractures: Does Age Matter?
Author(s) -
Mitchell Ian C.,
Norat Bradley J.,
Auerbach Marc,
Bressler Colleen J.,
Como John J,
Escobar Mauricio A.,
FlynnO’Brien Katherine T.,
Lindberg Daniel M.,
Nickoles Todd,
Rosado Norell,
Weeks Kerri,
Maguire Sabine
Publication year - 2021
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.14122
Subject(s) - medicine , cinahl , child abuse , pediatrics , poison control , injury prevention , medline , occupational safety and health , suicide prevention , specialty , physical abuse , psychiatry , emergency medicine , psychological intervention , pathology , political science , law
Objectives Child abuse is a significant cause of morbidity and mortality in preverbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We sought to determine which children presenting with rib or long‐bone fractures should undergo a routine abuse evaluation based on age. Methods A systematic review searching Ovid, PubMed/Medline, Scopus, and CINAHL from 1980 to 2020 was performed. An evidence‐based framework was generated by a consensus panel and applied to the results of the systematic review to form recommendations. Fifteen articles were suitable for final analysis. Results Studies with comparable age ranges of subjects and sufficient evidence to meet the determination of abuse standard for pediatric patients with rib, humeral, and femoral fractures were identified. Seventy‐seven percent of children presenting with rib fractures aged less than 3 years were abused; when those involved in motor vehicle collisions were excluded, 96% were abused. Abuse was identified in 48% of children less than 18 months with humeral fractures. Among those with femoral fractures, abuse was diagnosed in 34% and 25% of children aged less than 12 and 18 months, respectively. Conclusion Among children who were not in an independently verified incident, the authors strongly recommend routine evaluation for child abuse, including specialty child abuse consultation, for: 1) children aged less than 3 years old presenting with rib fractures and 2) children aged less than 18 months presenting with humeral or femoral fractures (Level of Evidence: III Review).