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J Trauma. 2003 Jun;54(6):1107-10.

The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children.

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1
Department of Surgery, The Children's Hospital, University of Colorado Health Sciences Center, Denver, USA. katherine.barsness@uchsc.edu

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.

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