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For Infants With Fractures: Involvement of a Child Protection Team Is Mandatory With Few Exceptions

Reto Bataenjer1, Michael Grotzer2, Michelle Seiler

  • 1From the Pediatric Emergency Department, University Children's Hospital.

Pediatric Emergency Care
|February 1, 2022
PubMed

Insights

Mandatory skeletal surveys detect more infant abuse than discretionary referrals to child protection teams (CPTs). Institutions without mandatory surveys should consult CPTs for every infant fracture case to improve abuse detection.

Area of Science:

  • Pediatrics
  • Child Abuse Detection
  • Forensic Medicine

Background:

  • Infant fractures can indicate nonaccidental trauma.
  • Current practices for identifying abuse in infants with fractures vary.
  • Child protection teams (CPTs) are involved in investigating suspected abuse.

Purpose of the Study:

  • To compare abuse detection rates between institutions using mandatory skeletal surveys and those with discretionary CPT referrals for infant fractures.
  • To analyze factors influencing CPT referrals in infant fracture cases.

Main Methods:

  • Retrospective chart review of infants diagnosed with fractures between 2014 and 2018.
  • Analysis of referral patterns to CPTs.
  • Determination of nonaccidental trauma frequency.

Main Results:

  • 72 infants (median age 6 months) were studied.
  • Skull fractures were most common (73.6%).
  • Discretionary CPT referral occurred in 25% of cases, with abuse detected in only 2.8%.

Conclusions:

  • Abuse detection is lower in institutions with discretionary CPT referral compared to mandatory skeletal surveys.
  • Recommend CPT consultation for all infant fractures in institutions lacking mandatory skeletal surveys.
Abstract

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