Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Fractures in Young Children: Distinguishing Child Abuse From Unintentional Injuries

Fractures in Young Children: Distinguishing Child Abuse From Unintentional Injuries Abstract • Objective. —To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries. Design. —Case series. Setting. —Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center). Patients. —Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse registry. Outcome Measure. —Each case was rated, by means of predefined criteria and a consensus of two clinicians and two pediatric radiologists, on a seven-point scale from "definite child abuse" to "definite unintentional injury." A middle rating of "unknown" was used if there was not enough information to reach a consensus. Results. —Of the 253 fractures in 215 children that were identified, we categorized 24.2% as abuse, 8.4% as unknown, and 67.4% as unintentional injuries. Fractures that were considered likely due to abuse were (1) fractures in children whose caretakers reported either a change in the child's behavior, but no accidental event, or a minor fall, but the injury was more severe than expected; (2) fractures of the radius/ulna, tibia/fibula, or femur in children less than 1 year of age; or (3) midshaft or metaphyseal fractures of the humerus. Linear fractures of the parietal bone were the most common skull fractures, whether due to abuse or unintentional injuries. Conclusion. —In young children with fractures, child abuse is common. By comparing fractures due to abuse and those due to unintentional injuries, we obtained empiric evidence to help clinicians and radiologists correctly examine children with such serious injuries.(AJDC. 1993;147:87-92) References 1. Schmitt BD. The child with nonaccidental trauma . In: Heifer RE, Kempe RS. The Battered Child. 4th ed. Chicago, Ill: Chicago University Press; 1987: 178-196. 2. Kleinman PK. Diagnostic Imaging of Child Abuse . Baltimore, Md: Williams & Wilkins; 1987. 3. Radkowski MA, Merten DF, Leonidas JC. The abused child: criteria for the radiologic diagnosis . Radiographic . 1983;3:262-297.Crossref 4. Merten DF, Radkowski MA, Leonidas JC. The abused child: a radiological reappraisal . Radiology . 1983;146:377-381. 5. Thomas SA, Rosenfield NS, Leventhal JM, Markowitz RI. Long-bone fractures in young children: distinguishing accidental injuries from child abuse . Pediatrics . 1991;88:471-476. 6. O'Neill JA. Patterns of injury in the battered child syndrome . J Trauma . 1973;13:332-339.Crossref 7. Galleno H, Oppenheim WL. The battered child syndrome revisited . Clin Orthop. 1982;162:11-19. 8. Akbarnia B, Torg JS, Kirkpatrick J, Sussman S. Manifestations of the battered-child syndrome . J Bone Joint Surg Am. 1984;56:1159-1166. 9. King J, Diefendorf D, Apthorp J, et al. Analysis of 429 fractures in 189 battered children . J Pediatr Orthop. 1988;8:584-589. 10. Anderson WA. The significance of femoral fractures in children . Ann Emerg Med. 1982;11:174-177.Crossref 11. Gross RH, Stranglar M. Causative factors responsible for femoral fractures in infants and young children . J Pediatr Orthop. 1983;3:341-343.Crossref 12. Beals RK, Tufts E. Fractured femur in infancy: the role of child abuse . J Pediatr Orthop. 1983;3:583-586.Crossref 13. Dalton HJ, Slovis T, Heifer RE, et al. Undiagnosed abuse in children younger than 3 years with femoral fracture . AJDC . 1990;144:875-878. 14. Hobbs CJ. Skull fracture and the diagnosis of abuse . Arch Dis Child. 1984;59:246-252.Crossref 15. Meservy CJ, Towbin R, McLaurin RL, et al. Radiographic characteristics of skull fractures resulting from child abuse . AJR Am J Roentgenol. 1987; 149:173-175.Crossref 16. McClelland CQ, Kingsbury GH. Fractures in the first year of life: a diagnostic dilemma? AJDC . 1982;136:26-29. 17. Rosenberg N, Bottenfield G. Fractures in infants: a sign of child abuse . Ann Emerg Med. 1982;11:178-180.Crossref 18. Warlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study . BMJ . 1986;293:100-102.Crossref 19. Ellerstein NS, Norris KJ. Value of radiologic skeletal survey in assessment of abused children . Pediatrics . 1984;74:1075-1078. 20. Section on Radiology, American Academy of Pediatrics. Diagnostic imaging of child abuse . Pediatrics . 1991;87:262-264. 21. Kravitz H, Driessen G, Gomberg R, Korach A. Accidental falls from elevated surfaces in infants from birth to one year of age . Pediatrics . 1969; 44( (suppl) ):869-876. 22. Helfer RE, Slovis TL, Black M. Injuries resulting when small children fall out of bed . Pediatrics . 1977;60:533-535. 23. Nimityongskul P, Anderson LD. The likelihood of injuries when children fall out of bed . J Pediatr Orthop. 1987;7:184-186.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Fractures in Young Children: Distinguishing Child Abuse From Unintentional Injuries

Download PDF
6 pages

Loading next page...
 
/lp/american-medical-association/fractures-in-young-children-distinguishing-child-abuse-from-dhoTwYfbJA

References (24)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1993.02160250089028
Publisher site
See Article on Publisher Site

Abstract

Abstract • Objective. —To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries. Design. —Case series. Setting. —Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center). Patients. —Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse registry. Outcome Measure. —Each case was rated, by means of predefined criteria and a consensus of two clinicians and two pediatric radiologists, on a seven-point scale from "definite child abuse" to "definite unintentional injury." A middle rating of "unknown" was used if there was not enough information to reach a consensus. Results. —Of the 253 fractures in 215 children that were identified, we categorized 24.2% as abuse, 8.4% as unknown, and 67.4% as unintentional injuries. Fractures that were considered likely due to abuse were (1) fractures in children whose caretakers reported either a change in the child's behavior, but no accidental event, or a minor fall, but the injury was more severe than expected; (2) fractures of the radius/ulna, tibia/fibula, or femur in children less than 1 year of age; or (3) midshaft or metaphyseal fractures of the humerus. Linear fractures of the parietal bone were the most common skull fractures, whether due to abuse or unintentional injuries. Conclusion. —In young children with fractures, child abuse is common. By comparing fractures due to abuse and those due to unintentional injuries, we obtained empiric evidence to help clinicians and radiologists correctly examine children with such serious injuries.(AJDC. 1993;147:87-92) References 1. Schmitt BD. The child with nonaccidental trauma . In: Heifer RE, Kempe RS. The Battered Child. 4th ed. Chicago, Ill: Chicago University Press; 1987: 178-196. 2. Kleinman PK. Diagnostic Imaging of Child Abuse . Baltimore, Md: Williams & Wilkins; 1987. 3. Radkowski MA, Merten DF, Leonidas JC. The abused child: criteria for the radiologic diagnosis . Radiographic . 1983;3:262-297.Crossref 4. Merten DF, Radkowski MA, Leonidas JC. The abused child: a radiological reappraisal . Radiology . 1983;146:377-381. 5. Thomas SA, Rosenfield NS, Leventhal JM, Markowitz RI. Long-bone fractures in young children: distinguishing accidental injuries from child abuse . Pediatrics . 1991;88:471-476. 6. O'Neill JA. Patterns of injury in the battered child syndrome . J Trauma . 1973;13:332-339.Crossref 7. Galleno H, Oppenheim WL. The battered child syndrome revisited . Clin Orthop. 1982;162:11-19. 8. Akbarnia B, Torg JS, Kirkpatrick J, Sussman S. Manifestations of the battered-child syndrome . J Bone Joint Surg Am. 1984;56:1159-1166. 9. King J, Diefendorf D, Apthorp J, et al. Analysis of 429 fractures in 189 battered children . J Pediatr Orthop. 1988;8:584-589. 10. Anderson WA. The significance of femoral fractures in children . Ann Emerg Med. 1982;11:174-177.Crossref 11. Gross RH, Stranglar M. Causative factors responsible for femoral fractures in infants and young children . J Pediatr Orthop. 1983;3:341-343.Crossref 12. Beals RK, Tufts E. Fractured femur in infancy: the role of child abuse . J Pediatr Orthop. 1983;3:583-586.Crossref 13. Dalton HJ, Slovis T, Heifer RE, et al. Undiagnosed abuse in children younger than 3 years with femoral fracture . AJDC . 1990;144:875-878. 14. Hobbs CJ. Skull fracture and the diagnosis of abuse . Arch Dis Child. 1984;59:246-252.Crossref 15. Meservy CJ, Towbin R, McLaurin RL, et al. Radiographic characteristics of skull fractures resulting from child abuse . AJR Am J Roentgenol. 1987; 149:173-175.Crossref 16. McClelland CQ, Kingsbury GH. Fractures in the first year of life: a diagnostic dilemma? AJDC . 1982;136:26-29. 17. Rosenberg N, Bottenfield G. Fractures in infants: a sign of child abuse . Ann Emerg Med. 1982;11:178-180.Crossref 18. Warlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study . BMJ . 1986;293:100-102.Crossref 19. Ellerstein NS, Norris KJ. Value of radiologic skeletal survey in assessment of abused children . Pediatrics . 1984;74:1075-1078. 20. Section on Radiology, American Academy of Pediatrics. Diagnostic imaging of child abuse . Pediatrics . 1991;87:262-264. 21. Kravitz H, Driessen G, Gomberg R, Korach A. Accidental falls from elevated surfaces in infants from birth to one year of age . Pediatrics . 1969; 44( (suppl) ):869-876. 22. Helfer RE, Slovis TL, Black M. Injuries resulting when small children fall out of bed . Pediatrics . 1977;60:533-535. 23. Nimityongskul P, Anderson LD. The likelihood of injuries when children fall out of bed . J Pediatr Orthop. 1987;7:184-186.Crossref

Journal

American Journal of Diseases of Children – American Medical Association

Published: Jan 1, 1993

There are no references for this article.