Format

Send to

Choose Destination
Child Abuse Negl. 2018 Feb;76:364-371. doi: 10.1016/j.chiabu.2017.11.008. Epub 2017 Nov 29.

Abusive fracture incidence over three decades at a level 1 pediatric trauma center.

Author information

1
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT, 06510, USA. Electronic address: melinda.sharkey@yale.edu.
2
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT, 06510, USA.
3
Yale Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT, 06511, USA.
4
Department of Surgery, Greenville Health System,701 Grove Road, Greenville, SC, 29605, USA.
5
Department of Pediatrics, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
6
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, P.O. Box 208042, 333 Cedar Street, New Haven, CT, 06520-8042, USA.
7
Department of Pediatrics, Yale University School of Medicine, P.O. Box 208064, 333 Cedar Street, New Haven, CT, 06520-8064, USA.

Abstract

Few studies have examined the incidence of abusive fractures in children. Only one study to date, from a single pediatric trauma center,has reported on the incidence of abusive fractures over time. That study showed a decrease in abusive fractures over a 24-year period. Our objective for this current study was to compare these published data with recent data from this same trauma center, allowing for a detailed comparison of the incidence of abusive fractures over a 30-year period. We included children <36months of age who presented to the emergency department of a level 1 pediatric trauma center (2007-2010) with≥1 fracture. Six experts from 3 different fields rated each case on the likelihood the fracture(s) was caused by abuse using an established 7- point scale, and a consensus rating was agreed upon for each case. The incidence of abusive fractures was calculated per 10,000 children <36months of age living in the geographic region and per 10,000 ED visits and was compared to previously published data for three prior time periods (1979-1983, 1991-1994, and 1999-2002) at the same pediatric trauma center. From 2007-2010, 551 children were identified, including 31 children who were rated as abused. The incidence of a child presenting with an abusive fracture in the county per year was 2.7/10,000 children <36months of age. The previous three time periods showed a countywide incidence of 3.2/10,000 (1979-1983), 1.7/10,000 (1991-1994), and 2.0/10,000 (1999-2002) (p for trend 0.34). The incidence per ED visit was 2.5/10,000 in the recent time period compared to 6.0/10,000 (1979-1983), 3.4/10,000 (1991-1994), and 2.5/10,000 (1999-2002) (p for trend <0.001). In this single institution review of fractures in children <36months of age, the incidence of abusive fractures has remained relatively constant over a 30-year period.

KEYWORDS:

Fractures; Incidence; Physical child abuse

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center