Identifying non-accidental fractures in children aged <2 years

Laura A. Leaman, William L. Hennrikus, James J. Bresnahan

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: Fractures are the second most common presentation of child abuse following soft-tissue bruising and burns. It is often difficult to determine potential abuse in a child presenting with a non-rib fracture(s) and without soft-tissue injuries. Methods: One hundred and fifteen consecutive patients aged ≤2 years who presented with a fracture between January 2010 and June 2012 to our emergency department (ED) or pediatric fracture clinic were retrospectively analyzed. Statistical analyses were carried out for non-accidental fractures based on age (<1 year vs 1–2 years), location of presentation (ED vs pediatric fracture clinic), type of long bone fracture, number of fractures, and patient demographics. Results: Fractures in 19 of 115 (17 %) patients were reported as non-accidental trauma (NAT). Eighty (70 %) of the 115 patients first reported to the ED. Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1–2 years were reported as NAT (p < 0.001). Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year. Eight of 11 (73 %) reported femoral fractures were transverse fractures. Corner fractures (12) only occurred in children aged <1 year and never occurred in isolation; all of them were reported as NAT. Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT. Conclusions: Age less than 1 year, multiple fractures, corner fractures, transverse fractures, and covered by Medicaid were the most common factors associated with reporting of NAT.

Original languageEnglish (US)
Pages (from-to)335-341
Number of pages7
JournalJournal of Children's Orthopaedics
Volume10
Issue number4
DOIs
StatePublished - Aug 1 2016

Fingerprint

Wounds and Injuries
Hospital Emergency Service
Medicaid
Pediatrics
Soft Tissue Injuries
Femoral Fractures
Child Abuse
Bone Fractures
Insurance
Burns
Demography
Multiple Fractures

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Leaman, Laura A. ; Hennrikus, William L. ; Bresnahan, James J. / Identifying non-accidental fractures in children aged <2 years. In: Journal of Children's Orthopaedics. 2016 ; Vol. 10, No. 4. pp. 335-341.
@article{d30995ac30a44994b0d9cd6514dcc7cb,
title = "Identifying non-accidental fractures in children aged <2 years",
abstract = "Purpose: Fractures are the second most common presentation of child abuse following soft-tissue bruising and burns. It is often difficult to determine potential abuse in a child presenting with a non-rib fracture(s) and without soft-tissue injuries. Methods: One hundred and fifteen consecutive patients aged ≤2 years who presented with a fracture between January 2010 and June 2012 to our emergency department (ED) or pediatric fracture clinic were retrospectively analyzed. Statistical analyses were carried out for non-accidental fractures based on age (<1 year vs 1–2 years), location of presentation (ED vs pediatric fracture clinic), type of long bone fracture, number of fractures, and patient demographics. Results: Fractures in 19 of 115 (17 {\%}) patients were reported as non-accidental trauma (NAT). Eighty (70 {\%}) of the 115 patients first reported to the ED. Thirty-two percent of fractures in children aged <1 year and 5 {\%} of fractures in children aged 1–2 years were reported as NAT (p < 0.001). Sixteen of 19 (84 {\%}) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year. Eight of 11 (73 {\%}) reported femoral fractures were transverse fractures. Corner fractures (12) only occurred in children aged <1 year and never occurred in isolation; all of them were reported as NAT. Four of 60 patients (7 {\%}) with commercial insurance and 15 of 55 patients (28 {\%}) with Medicaid were reported as NAT. Conclusions: Age less than 1 year, multiple fractures, corner fractures, transverse fractures, and covered by Medicaid were the most common factors associated with reporting of NAT.",
author = "Leaman, {Laura A.} and Hennrikus, {William L.} and Bresnahan, {James J.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1007/s11832-016-0755-3",
language = "English (US)",
volume = "10",
pages = "335--341",
journal = "Journal of Children's Orthopaedics",
issn = "1863-2521",
publisher = "Springer Verlag",
number = "4",

}

Identifying non-accidental fractures in children aged <2 years. / Leaman, Laura A.; Hennrikus, William L.; Bresnahan, James J.

In: Journal of Children's Orthopaedics, Vol. 10, No. 4, 01.08.2016, p. 335-341.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Identifying non-accidental fractures in children aged <2 years

AU - Leaman, Laura A.

AU - Hennrikus, William L.

AU - Bresnahan, James J.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Purpose: Fractures are the second most common presentation of child abuse following soft-tissue bruising and burns. It is often difficult to determine potential abuse in a child presenting with a non-rib fracture(s) and without soft-tissue injuries. Methods: One hundred and fifteen consecutive patients aged ≤2 years who presented with a fracture between January 2010 and June 2012 to our emergency department (ED) or pediatric fracture clinic were retrospectively analyzed. Statistical analyses were carried out for non-accidental fractures based on age (<1 year vs 1–2 years), location of presentation (ED vs pediatric fracture clinic), type of long bone fracture, number of fractures, and patient demographics. Results: Fractures in 19 of 115 (17 %) patients were reported as non-accidental trauma (NAT). Eighty (70 %) of the 115 patients first reported to the ED. Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1–2 years were reported as NAT (p < 0.001). Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year. Eight of 11 (73 %) reported femoral fractures were transverse fractures. Corner fractures (12) only occurred in children aged <1 year and never occurred in isolation; all of them were reported as NAT. Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT. Conclusions: Age less than 1 year, multiple fractures, corner fractures, transverse fractures, and covered by Medicaid were the most common factors associated with reporting of NAT.

AB - Purpose: Fractures are the second most common presentation of child abuse following soft-tissue bruising and burns. It is often difficult to determine potential abuse in a child presenting with a non-rib fracture(s) and without soft-tissue injuries. Methods: One hundred and fifteen consecutive patients aged ≤2 years who presented with a fracture between January 2010 and June 2012 to our emergency department (ED) or pediatric fracture clinic were retrospectively analyzed. Statistical analyses were carried out for non-accidental fractures based on age (<1 year vs 1–2 years), location of presentation (ED vs pediatric fracture clinic), type of long bone fracture, number of fractures, and patient demographics. Results: Fractures in 19 of 115 (17 %) patients were reported as non-accidental trauma (NAT). Eighty (70 %) of the 115 patients first reported to the ED. Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1–2 years were reported as NAT (p < 0.001). Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year. Eight of 11 (73 %) reported femoral fractures were transverse fractures. Corner fractures (12) only occurred in children aged <1 year and never occurred in isolation; all of them were reported as NAT. Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT. Conclusions: Age less than 1 year, multiple fractures, corner fractures, transverse fractures, and covered by Medicaid were the most common factors associated with reporting of NAT.

UR - http://www.scopus.com/inward/record.url?scp=84976320052&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84976320052&partnerID=8YFLogxK

U2 - 10.1007/s11832-016-0755-3

DO - 10.1007/s11832-016-0755-3

M3 - Article

AN - SCOPUS:84976320052

VL - 10

SP - 335

EP - 341

JO - Journal of Children's Orthopaedics

JF - Journal of Children's Orthopaedics

SN - 1863-2521

IS - 4

ER -