Diagnostic imaging in infant abuse.

Kleinman, Paul K.

doi:10.2214/ajr.155.4.2119097

Cited by 146 publications

(104 citation statements)

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“…21,29 CMLs are the most common long bone fracture found in infants who die with evidence of inflicted injury. 30 CMLs are planar fractures through the primary spongiosa of the metaphysis.…”

Section: Fractures With High Specificity For Abusementioning

confidence: 99%

“…21 Rib fractures in infants, especially those situated posteromedially, and the classic metaphyseal lesions of long bones, have high specificity for child abuse. Fractures of the scapula, spinous process, and sternum also have high specificity for abuse but are uncommon.…”

Section: Fractures With High Specificity For Abusementioning

confidence: 99%

“…Rib fractures have high probability of being caused by abuse. 15,17,21 The positive predictive value of rib fractures for child abuse in children younger than 3 years was 95% in one retrospective study. 22 Other less common causes of rib fractures in infants include significant trauma sustained during childbirth or a motor vehicle crash as well as minor trauma in infants who have increased bone fragility.…”

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confidence: 99%

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Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

247

162

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Fractures are common injuries caused by child abuse. Although the consequences of failing to diagnose an abusive injury in a child can be grave, incorrectly diagnosing child abuse in a child whose fractures have another etiology can be distressing for a family. The aim of this report is to review recent advances in the understanding of fracture specificity, the mechanism of fractures, and other medical diseases that predispose to fractures in infants and children. This clinical report will aid physicians in developing an evidence-based differential diagnosis and performing the appropriate evaluation when assessing a child with fractures. Pediatrics 2014;133:e477-e489 INTRODUCTIONFractures are the second most common injury caused by child physical abuse; bruises are the most common injury. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 2-4 Physical abuse may not be considered in the physician' s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted. 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family. To identify child abuse as the cause of fractures, the physician must take into consideration the history, the age of the child, the location and type of fracture, the mechanism that causes the particular type of fracture, and the presence of other injuries while also considering other possible causes. DIFFERENTIAL DIAGNOSIS OF FRACTURES Trauma: Child Abuse Versus Noninflicted InjuriesFractures are a common childhood injury and account for between 8% and 12% of all pediatric injuries. [6][7][8] In infants and toddlers, physical FROM THE AMERICAN ACADEMY OF PEDIATRICSGuidance for the Clinician in Rendering Pediatric Care by guest on May 11, 2018 http://pediatrics.aappublications.org/ Downloaded from abuse is the cause of 12% to 20% of fractures. 9 Although unintentional fractures are much more common than fractures caused by child abuse, the physician needs to remain aware of the possibility of inflicted injury. Although some fracture types are highly suggestive of physical abuse, no pattern can exclude child abuse. 10,11 Specifically, it is important to recognize that any fracture, even fractures that are commonly noninflicted injuries, can be caused by child abuse. Certain details that can help the physician determine whether a fracture was caused by abuse rather than unintentional injury include the hist...

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“…21,29 CMLs are the most common long bone fracture found in infants who die with evidence of inflicted injury. 30 CMLs are planar fractures through the primary spongiosa of the metaphysis.…”

Section: Fractures With High Specificity For Abusementioning

confidence: 99%

Section: Fractures With High Specificity For Abusementioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

247

162

View full text Add to dashboard Cite

show abstract

“…4 A study about specificity of radiological findings discovered that posterior rib fractures have a high specificity value and the fractures are usually multiple. [5][6][7] In this case, rib fractures occurred posteriorly and multiple.…”

Section: Discussionmentioning

confidence: 99%

Skull and Posterior Rib Fractures with Respiratory Failure caused by Child Abuse

Hakim¹,

Noviani²

2017

amj

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Background: Presence of multiple fractures suggests child abuse. Skull fractures rarely occurred but posterior rib fractures are commonly found and have high specificity as a radiological finding in child abuse. A respiratory failure can occur as a result of the damage to the osseous structure of the thorax that destabilizes the rib cage and impairs spontaneous breathing mechanism. Methods: A case report of a 6-month-old boy who presented with respiratory failure, multiple bilateral parietal and occipital bone fractures, and also fractures of right rib 5-8. The patient required ventilatory support for 9 days in the Pediatric Intensive Care Unit, Dr.HasanSadikin General Hospital. Results: The patient was on ventilatory support for 9 days, and was given antibiotics for 2 weeks. Next, the patient was referred to the High Care Unit (HCU) after the condition was stabilized, and then referred to the ward, for treatment by the Social Pediatric Division. The patient was still having issues about his foster care.

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“…1 1 , see also (see Figs. 1 1 B and 1 1C), are highly specific of child abuse [64][65][66]. Transverse, oblique, or spinal fracture of a long bone with normal mineralization (see Fig.…”

Section: Distinguishing Osteogenesis Imperfecta From Child Abusementioning

confidence: 99%