This article is more than 5 years old. Information may no longer be current.
Rib fractures usually signal child abuse in patients less than 48 months old
Patient age and fracture pattern, not gender, can distinguish between abuse and accidental trauma.
Click Here to Manage Email Alerts
Fracture pattern and patient age were the main predictors of child abuse vs. accidental trauma in a retrospective review of the origins of these pediatric injuries.
Rib fractures and most extremity fractures in patients less than 18 months-old had a greater likelihood of being abuse-related, while long bone fractures in children older than 18 months, except those in the tibia and fibula, were more likely related to accidental trauma, according to the findings.
Gender did not predict either type of injury, noted Nirav K. Pandya, MD, who presented the study at the American Academy of Orthopaedic Surgeons annual meeting.
Fracture patterns can suggest a potential etiology to these injuries, but should not be used alone to distinguish if they were caused by abuse or accidental trauma, he said. “A detailed history and physical exam are still essential so multidisciplinary intervention and child protection can be initiated.”
Databases used
In studying these fractures, Pandya and colleagues devised a clinical algorithm for using this information. “We hope the diagnosis of child abuse can be made in a more reproducible fashion in the future,” he said.
Investigators identified 500 child abuse patients in the Children’s Hospital of Philadelphia Suspected Child Abuse and Neglect database between 1998 and 2007 who met inclusion criteria for injury type and age — between 0 to 48 months-old. They compared this group to 985 same-aged accidental trauma patients in another database between 2000 and 2003.
From statistical analyses performed to identify differences between the abuse and trauma cases, Pandya said they found a significant difference between the ages of the child-abuse and the trauma patients. Average ages were 11.7 months in the child abuse group and 22.1 months in the trauma group.
Rib fractures and abuse
Among all patients, fractures of the ribs, tibia/fibula, radius/ulna and clavicle were more likely to be associated with abuse than accidental trauma.
In the 0- to 18-month-old group, rib fractures had a 23.7 odds ratio for being abuse-related. Odds ratios for other fractures being related to abuse were lower, but also significant: 12.8 for tibia/fibula, 2.3 for humerus and 1.8 for femur fractures. In the group older than 18 months, a rib fracture was the only indicator of abuse, whereas femur and humerus fractures were more likely to stem from accidental trauma, Pandya said.
He said apply this information when evaluating young children in the emergency room; if they have a rib fracture there should be a high suspicion of abuse. If not, abuse may be suspected in association with any higher-risk fractures the investigators identified.
For more information:Reference:
- Nirav K. Pandya, MD, can be reached in the Department of Orthopaedic Surgery, University of Pennsylvania Health System, 235 S. 33rd St., Philadelphia, PA 19104; 215-615-4436; e-mail: nirav.pandya@uphs.upenn.edu. He has no direct financial interest in any companies or products mentioned in this article.
- Pandya NK, Baldwin KD, Hosalkar HS, et al. Child abuse and orthopaedic injury patterns: Analysis at a level 1 pediatric trauma center. Paper #587. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.