Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Dr. James Anderst
Start Date
15-5-2025 11:30 AM
End Date
15-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background-
Existing data characterizes the relationship between prior concerning injuries (PCI) in infants preceding abusive head trauma (AHT). Little data exists on the relationship between PCI and other abusive injuries, in particular fractures. As AHT and abusive fractures differ in epidemiology and inciting events, it is possible that the frequency, type, and age of occurrence of PCI preceding abusive fractures may differ.
Objectives/Goals-
We aim to compare the frequency and number of PCI known to a Child Abuse Pediatrician (CAP) at the time of evaluation between children with abusive and non-abusive fractures.
Methods/Design-
This was a retrospective, case-control study using data from CAPNET, a research network of 10 Child Protection Teams, over a 27-month period. Study subjects were less than 4 years old, had fractures, in-person CAP consultation, and did not have intracranial hemorrhage. The prevalence and number of PCI was compared between abuse cases and non-abuse controls. Abuse was defined in two different ways to help mitigate circular reasoning. Analysis 1 compared the prevalence and number of PCI among subjects with a score of 5-7 on a 7-point scale to identify likelihood of abuse cases to subjects with a score of 1-2. For Analysis 2, a combination of mobility, history, presence of concomitant suspicious injuries (CSI), and fracture specificity for abuse were used a priori identify abused cases and controls. CSIs were defined as bruising and/or petechiae specific for abuse, subconjunctival hemorrhage (SCH) outside of birth, burns, multiple fractures, fractures of different ages, and abdominal injury. Unadjusted odds ratios and 95% confidence intervals were calculated.
Results -
There were 1339 study subjects with a median age of 8 months (interquartile range 3.8 to 13.9 months). Analysis 1 identified 403 subjects with abusive fractures, and Analysis 2 identified 644 subjects with abusive fractures. The prevalence of PCI in the abused groups in Analyses 1 and 2, respectively, were 30% and 22% as compared to 8% and 5% among controls. In Analysis 1, abused subjects had higher odds of any PCI than the non-abused group (OR 4.5, 95% CI 3.2-6.1). This association remained in subjects with one (OR 3.4, 95% CI 2.4-4.9) and multiple PCI (OR 11.7, 95% CI 5.8-23.8). In Analysis 2, any PCI were also more common in immobile (OR 5.9, 95% CI 3.1-11.3) and mobile abuse group (OR 3.0, 95% CI 1.6 to 5.6) when compared to same level of mobility non-abuse groups. This association remained in immobile subjects with one (OR 5.1, 95% CI 2.5-10.4) and multiple PCI (OR 9.5, 95% CI 2.2-40.0). Similarly, the association remained in mobile subjects with one (OR 2.1, 95% CI 1.1-4.0) and multiple PCI (OR 33.3, 95% CI 1.9-572.6).
Conclusions -
The most common PCI in this study were bruises followed by oral injuries, prior fractures, and SCH. Children who suffered abusive fractures were more likely to have a PCI, and the strength of this association increased with more PCI. This data supports the idea that abuse is commonly a chronic, escalating disease, and that improved early recognition has the potential to prevent significant injuries.
Identifying Prior Concerning Injuries in Children with Abusive Fractures
Background-
Existing data characterizes the relationship between prior concerning injuries (PCI) in infants preceding abusive head trauma (AHT). Little data exists on the relationship between PCI and other abusive injuries, in particular fractures. As AHT and abusive fractures differ in epidemiology and inciting events, it is possible that the frequency, type, and age of occurrence of PCI preceding abusive fractures may differ.
Objectives/Goals-
We aim to compare the frequency and number of PCI known to a Child Abuse Pediatrician (CAP) at the time of evaluation between children with abusive and non-abusive fractures.
Methods/Design-
This was a retrospective, case-control study using data from CAPNET, a research network of 10 Child Protection Teams, over a 27-month period. Study subjects were less than 4 years old, had fractures, in-person CAP consultation, and did not have intracranial hemorrhage. The prevalence and number of PCI was compared between abuse cases and non-abuse controls. Abuse was defined in two different ways to help mitigate circular reasoning. Analysis 1 compared the prevalence and number of PCI among subjects with a score of 5-7 on a 7-point scale to identify likelihood of abuse cases to subjects with a score of 1-2. For Analysis 2, a combination of mobility, history, presence of concomitant suspicious injuries (CSI), and fracture specificity for abuse were used a priori identify abused cases and controls. CSIs were defined as bruising and/or petechiae specific for abuse, subconjunctival hemorrhage (SCH) outside of birth, burns, multiple fractures, fractures of different ages, and abdominal injury. Unadjusted odds ratios and 95% confidence intervals were calculated.
Results -
There were 1339 study subjects with a median age of 8 months (interquartile range 3.8 to 13.9 months). Analysis 1 identified 403 subjects with abusive fractures, and Analysis 2 identified 644 subjects with abusive fractures. The prevalence of PCI in the abused groups in Analyses 1 and 2, respectively, were 30% and 22% as compared to 8% and 5% among controls. In Analysis 1, abused subjects had higher odds of any PCI than the non-abused group (OR 4.5, 95% CI 3.2-6.1). This association remained in subjects with one (OR 3.4, 95% CI 2.4-4.9) and multiple PCI (OR 11.7, 95% CI 5.8-23.8). In Analysis 2, any PCI were also more common in immobile (OR 5.9, 95% CI 3.1-11.3) and mobile abuse group (OR 3.0, 95% CI 1.6 to 5.6) when compared to same level of mobility non-abuse groups. This association remained in immobile subjects with one (OR 5.1, 95% CI 2.5-10.4) and multiple PCI (OR 9.5, 95% CI 2.2-40.0). Similarly, the association remained in mobile subjects with one (OR 2.1, 95% CI 1.1-4.0) and multiple PCI (OR 33.3, 95% CI 1.9-572.6).
Conclusions -
The most common PCI in this study were bruises followed by oral injuries, prior fractures, and SCH. Children who suffered abusive fractures were more likely to have a PCI, and the strength of this association increased with more PCI. This data supports the idea that abuse is commonly a chronic, escalating disease, and that improved early recognition has the potential to prevent significant injuries.
