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Fractures in the Pediatric Emergency Department: Are We Considering Abuse?

Lindsay R Lavin1,2, Cody H Penrod1, Cristina M Estrada1

  • 11 Vanderbilt University, Nashville, TN, USA.

Clinical Pediatrics
|February 17, 2018
PubMed

Insights

Pediatric emergency physicians considered abuse in two-thirds of infant fracture cases. Factors like younger age and unwitnessed injury increased abuse consideration, aiding early detection and prevention of harm.

Area of Science:

  • Pediatrics
  • Emergency Medicine
  • Child Abuse Recognition

Background:

  • Infant fractures are frequently caused by abuse, necessitating prompt recognition to prevent severe outcomes.
  • Limited data exists on the frequency with which pediatric emergency clinicians suspect abuse in infants with fractures.

Purpose of the Study:

  • To determine the percentage of infants with fractures for whom abuse was considered in a pediatric emergency department.
  • To identify characteristics associated with the consideration of abuse in these cases.

Main Methods:

  • Retrospective review of medical records for infants under 1 year of age presenting with fractures.
  • Primary outcome: consideration of abuse; Secondary outcomes: predictor variables for abuse consideration.

Main Results:

  • Abuse was considered in approximately two-thirds of 509 infants with fractures.
  • Consideration of abuse was higher in younger infants, those with no history or unwitnessed injury, and during nighttime emergency department evaluations (12 am–6 am).
  • Evaluation by male physicians was also associated with increased abuse consideration.

Conclusions:

  • Pediatric emergency physicians consider abuse in a majority of infant fracture cases.
  • Younger age, lack of clear injury history, unwitnessed events, and nighttime evaluations are key indicators for considering abuse.
  • Further research may refine protocols for identifying abusive head trauma and non-accidental trauma in infants.

Keywords:
child physical abuseinfant fracture

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