Citation

Mitchell IC, Norat BJ, Auerbach M, Bressler CJ, Como J, Escobar MA, Flynn-O'Brien KT, Lindberg DM, Nickoles T, Rosado N, Weeks K, Maguire S. Acad. Emerg. Med. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/acem.14122

PMID

32888348

Abstract

BACKGROUND: Child abuse is a significant cause of morbidity and mortality in re-verbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We aim to determine which children presenting with rib or long bone fractures should undergo a routine abuse evaluation based on age.

METHODS: A systematic review searching Ovid, PubMed/Medline, Scopus and CINAHL from 1980-2020 was performed. An evidence-based framework was generated by a consensus panel and applied to the results of the systematic review to form recommendations. Fifteen articles were suitable for final analysis.


RESULTS: Studies with comparable age ranges of subjects and sufficient evidence to meet the determination of abuse standard for pediatric patients with rib, humeral and femoral fractures were identified. Seventy-seven percent of children presenting with rib fractures aged less than three years were abused; when those involved in motor vehicle collisions were excluded, 96% were abused. Abuse was identified in 48% of children less than 18 months with humeral fractures. Among those with femoral fractures, abuse was diagnosed in 34% and 25% of children aged less than 12 months and 18 months, respectively.

CONCLUSION: Among children who were not in an independently verified incident, the authors strongly recommend routine evaluation for child abuse, including specialty child abuse consultation, for: (1) children aged less than 3 years old presenting with rib fractures, and (2) children aged less than 18 months presenting with humeral or femoral fractures.

Language: en

Keywords

Child abuse; Systematic review; Fracture; Femur; Humerus; Rib