Fractures Presumed to Be Low Risk for Abuse in Young Mobile Children: Association With Concomitant Suspicious Injuries.
Document Type
Article
Publication Date
1-1-2022
Identifier
DOI: 10.1097/PEC.0000000000002161
Abstract
OBJECTIVES: To evaluate the likelihood of abuse for various fractures, we aimed to compare the prevalence of concomitant suspicious injuries (CSIs) in subjects with fractures presumed to be low risk for abuse to those with non-low-risk fractures (aim 1) and to evaluate the prevalence of low-risk and non-low-risk fractures identified on skeletal survey (SS) (aim 2).
METHODS: Subjects included toddlers 9 to 23 months of age presenting to a children's hospital system with a fracture and having an SS completed (aim 1) as well as those who had an SS completed for any concern for abuse (aim 2). For aim 1, we performed a 5-year retrospective case-control study. Low-risk fractures were defined as extremity buckle, clavicle, supracondylar, or toddler's fractures. Controls included moderate- and high-risk fracture groups. Groups were compared for the prevalence of CSIs. For aim 2, we described the frequencies of all fracture types identified by SS completed for any concern for abuse over the same period.
RESULTS: For aim 1, there were 58 low-risk, 92 moderate-risk, and 8 high-risk fractures. The rates of CSIs were not significantly different between low- and moderate-risk fractures (odds ratio, 0.9; 95% confidence interval, 0.4-2.5), whereas half of high-risk fractures had CSIs. Forty-five subjects had an occult fracture on SS completed for any abuse concern. All low-risk fractures were identified by SS, most commonly buckle fractures (22.2% of cases).
CONCLUSIONS: Fractures presumed to be low risk for abuse in young, mobile children require consideration of abuse as a cause.
Journal Title
Pediatric emergency care
Volume
38
Issue
1
First Page
5
Last Page
11
MeSH Keywords
Case-Control Studies; Child; Child Abuse; Fractures, Bone; Fractures, Closed; Humans; Infant; Retrospective Studies; Tibial Fractures
Keywords
Case-Control Studies; Child Abuse; Bone Fractures; Closed Fractures; Retrospective Studies; Tibial Fractures
Recommended Citation
Murray L, Fickenscher K, Moffatt M, Frazier T, Jackson J, Anderst J. Fractures Presumed to Be Low Risk for Abuse in Young Mobile Children: Association With Concomitant Suspicious Injuries. Pediatr Emerg Care. 2022;38(1):e5-e11. doi:10.1097/PEC.0000000000002161
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