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Evaluation of child-abuse victims for fractures varies across hospitals
The evaluation practices for occult fractures in pediatric patients diagnosed with abuse varies significantly across U.S. hospitals, revealing an area for improvement in quality of care, according to a recent study.
“Our results show a lack of uniform adherence to occult fracture evaluation recommendations in young victims of abuse,” Joanne N. Wood, MD, MSHP, of the division of general pediatrics and at The Children’s Hospital of Philadelphia, and colleagues wrote. “The marked variation in occult fracture evaluation rates among infants with high-risk injuries raises concerns for missed opportunities to detect abuse and protect children.”
Researchers gathered a cohort of 4,486 pediatric patients aged younger than 2 years with a diagnosis of abuse and children aged younger than 1 year with a non-motor vehicle crash related brain injury or femur fracture. This data was collected from 366 hospitals, using a large database that includes medical information from more than 2,000 hospitals and clinics.
Study results showed that only 48% of the children aged younger than 2 years were evaluated for occult fractures. AAP recommendations state that skeletal surveys should be universally performed in this population, in which previous studies have found that about 25% to 30% are likely to have occult fractures as a result of child abuse. Evaluations of children diagnosed with non-motor vehicle crash related brain injury (51%) or femur fracture (53%) also followed this trend, with about only half having been evaluated.
Study results also found that the rate of evaluation differed across hospital type and population. Teaching hospitals were more likely to perform evaluations for occult fractures than nonteaching hospitals (P < .001). Likewise, hospitals with a higher frequency of pediatric patients tended to perform evaluations for occult fractures more often (P < .001).
Study researchers emphasize that these results highlight a specific lapse in the treatment of this vulnerable patient population, warranting actions for improvement of hospital procedures.
“Skeletal survey is a key component of the evaluation of young children. In addition to identifying fractures requiring medical treatment, skeletal surveys can document fractures and other findings that do not require medical treatment but are important to safeguard the well-being of the child,” Wood and colleagues wrote. – by David Costill
Disclosure: Wood reports receiving payment for expert witness court testimony that she provided in cases of suspected child abuse for which she was subpoenaed to testify; as well as salary funding from the National Institute of Child Health and Human Development grant. Please see the full study for a list of all other authors’ relevant financial disclosures.
