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Dtsch Arztebl Int. 2018 Nov 16;115(46):769-775. doi: 10.3238/arztebl.2018.0769.

Abuse as a Cause of Childhood Fractures.

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1
DRK Kliniken Berlin | Westend, Department of Pediatrics, Child Protection Outpatient Clinic; DRK Kliniken Berlin | Westend, Department of Diagnostic and Interventional Radiology; DRK Kliniken Berlin | Westend, Department of Trauma Surgery and Orthopedics; Department of Child and Adolescent Psychiatry/Psychotherapy.

Abstract

BACKGROUND:

It is well known that physical abuse of children all too often escapes detection. Fractures are among the potential consequences of physical abuse but are also com- mon in childhood because of accidents. A question frequently addressed to the Medical Child Protection Hotline (Medizini- sche Kinderschutzhotline) is how fractures due to abuse can be distinguished from accidental fractures.

METHODS:

This review is based on pertinent publications retrieved by a search in PubMed and in the Cochrane Data- base, as well as on the authors' experience in a pediatric emergency department with ca. 29 000 consultations per year and in a child protection outpatient clinic with ca. 100 consultations per year.

RESULTS:

Fractures due to abuse are especially common among infants; their incidence is estimated at 56.8/100 000 among infants less than six months old and 39.8/100 000 among infants aged 6 to 11 months. In consideration of the age of the child, the type of fracture, the history, and other factors, a high probability of abuse can be suspected in many cases, so that further measures can be initiated.

CONCLUSION:

All physicians involved in the care of children (even if only occasionally) should be aware of the major indicators of likely physical abuse and of the available oppor- tunities for counseling and intervention. Failures to diagnose child abuse are associated with high rates of recurrence and mortality.

PMID:
30602409
PMCID:
PMC6329369
DOI:
10.3238/arztebl.2018.0769
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