@article{ref1,
title="The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children",
journal="Journal of trauma",
year="2003",
author="Strain, John D. and Karrer, Frederick M. and Partrick, David A. and Calkins, Casey M. and Bensard, Denis D. and Cha, Eun Shil and Barsness, Katherine A.",
volume="54",
number="6",
pages="1107-1110",
abstract="BACKGROUND: Rib fractures have a strong association with nonaccidental trauma (NAT) and severe trauma. The purposes of this study were to evaluate rib fractures in children to determine (1) the positive predictive value of a rib fracture in defining NAT and (2) the frequency of rib fractures as the only skeletal manifestation of NAT. METHODS: We reviewed the medical records and imaging of all children with rib fractures over a 6-year period. NAT was determined by the Child Advocacy and Protection team. RESULTS: In children younger than 3 years of age, the positive predictive value (PPV) of a rib fracture as an indicator of NAT was 95%. The positive predictive value increased to 100% once historical and clinical circumstance excluded all other causes for rib fractures. CONCLUSION: In this study, rib fracture(s) were the only skeletal manifestation of NAT in 29% of the children.",
language="",
issn="0022-5282",
doi="10.1097/01.TA.0000068992.01030.A8",
url="http://dx.doi.org/10.1097/01.TA.0000068992.01030.A8"
}