Evaluation of suspected physical abuse in children: a 500-case study

Abstract

ObjectiveThis study evaluated the epidemiological profile of patients with suspected physical abuse, especially regarding the occurrence of fractures, treated in a referral hospital.MethodsThe authors reviewed all reports of suspected abuse against children and adolescents (AACA) in this hospital from January 2005 to December 2015. They were assessed and separated by month and year. The characteristics of the victims of physical abuse with occurrence of fractures were studied. The features of the fractures were evaluated in those patients with available radiographs.ResultsOf the 3125 notifications, 500 were classified as physical injuries; of these, 63 had fractures. An annual progressive increase in notifications was observed. As for age group, 50 patients (80.6%) were up to three years old and 36 (58%) up to one year. Most were male (60%) and the likely aggressors were mother alone and both parents (27.5% each). In 30 patients with available images, fractures of long bones (femur, tibia, and humerus) predominated (71%), as well as a single fracture line (74%), diaphyseal location (73%), and a transverse line (57%). There were two deaths in fracture cases (3%).ConclusionAll orthopedists should be alert to suspected AACA in children with trauma below the age of three, even without classic signs of abuse.

Nonaccidental Trauma in Pediatric Elbow Fractures: When You Should Be Worried

“…This study, like many other retrospective studies assessing rates of NAT, is limited by the fact that outcomes from DCS investigations are many times not definitive. As such, studies in this field of research must rely on proxies and documentation available to determine the primary endpoint and presence of NAT 8,17,37,38. In addition to the possibility that cases of NAT were missed upon presentation,8 it is also likewise possible that cases were not identified retrospectively in this study due to insufficient documentation by the provider.…”

“…As such, studies in this field of research must rely on proxies and documentation available to determine the primary endpoint and presence of NAT. 8,17,37,38 In addition to the possibility that cases of NAT were missed upon presentation, 8 it is also likewise possible that cases were not identified retrospectively in this study due to insufficient documentation by the provider. The authors believe that the criteria outlined to classify patients as victims of NAT within this study are of sufficient quality to identify the greatest number of cases possible given these limitations.…”