Wood JN, Henry MK, Berger RP, Lindberg DM, Anderst JD, Song L, Localio R, Feudtner C. Acad. Pediatr. 2019; 19(4): 428-437.
Affiliation
Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA 19146; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA 19104.
OBJECTIVES: To describe the percentage and characteristics of children <24 months old with non-motor vehicle crash (non-MVC)-related injuries who 1) undergo a skeletal survey and 2) have occult fractures.
METHODS: We performed a retrospective chart review of a stratified, systematic random sample of 1769 children <24 months old with non-MVC-related bruises, burns, fractures, abdominal injuries, and head injuries at 4 children's hospitals from 2008-2012. Sampling weights were assigned to each child to allow for representative hospital-level population estimates. Logistic regression models tested for associations between patient characteristics with outcomes of skeletal survey completion and occult fracture identification.
RESULTS: Skeletal surveys were performed in 46.3% of 0-5 month olds, 21.1% of 6-11 month olds, 8.0% of 12-17 month olds and 6.2% of 18-24 month olds. Skeletal surveys were most performed in children with traumatic brain injuries (64.7%) and rib fractures (100%) and least in burns (2.1%) and minor head injuries (4.4%). In adjusted analyses, increased age, private insurance and reported history of accidental trauma were associated with decreased skeletal survey use (all p≤0.001). The prevalence of occult fractures on skeletal survey ranged from 24.6% in infants 0-5 month olds to 3.6% in 18-24 month olds, and varied within age categories based on the presenting injury (p<0.001).
CONCLUSIONS: The high rate of occult fractures in infants 0-5 months old underscores the importance of increasing the use of skeletal surveys in this population. Further research is needed to identify the injury characteristics of older infants and toddlers most at risk for occult fractures.