Intracranial Injury Among Children with Abuse-Related Long Bone Fractures

Area of Science:

• Pediatric Traumatology
• Child Abuse Detection
• Forensic Pediatrics

Background:

• Abusive head trauma is a leading cause of death in young abused children, often presenting with difficult-to-detect intracranial injury (ICI).
• Long bone fractures (LBF) in children can serve as an indicator for underlying abuse, prompting further investigation.

Purpose of the Study:

• This study aimed to determine the incidence and characteristics of intracranial injury (ICI) in young children diagnosed with abuse-related long bone fractures (LBF).
• It is the first study to report on the incidence and features of ICI in this specific pediatric population.

Main Methods:

• A retrospective analysis was conducted using data from the National Trauma Data Bank (2009-2014) for children under 3 years old with LBF.
• International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify LBF, abuse, and clinical features.
• Risk factors for ICI were identified by comparing abuse-related LBF cases with and without ICI.

Main Results:

• Out of 4345 encounters for abuse-related LBF in children under 3, 970 (22%) had associated ICI.
• Infants under 1 year were more likely to have ICI (OR 1.79).
• Fractures of the ulna, radius, tibia, or fibula (OR 3.35), skull fractures (OR 8.27), rib fractures (OR 2.67), and head/neck bruising (OR 2.41) were associated with increased odds of ICI.

Conclusions:

• Nearly one in four children under 3 with abuse-related LBF experienced ICI.
• The presence of skull fracture, rib fracture, head/neck bruising, or age under 1 year in cases of abuse-related LBF should prompt consideration for ICI.
• Head imaging is recommended in these high-risk cases to detect potential intracranial injury.