Fractures in the Pediatric Emergency Department: Are We Considering Abuse?

Abstract

Approximately one fourths of infant fractures are due to abuse. Recognition of abuse is important to avoid further morbidity/mortality. There is limited knowledge regarding how frequently pediatric emergency department clinicians consider abuse in infants with fractures. Our primary objective was to estimate the percentage of infants with fractures for whom abuse was considered, and to examine characteristics associated with abuse consideration. We performed a retrospective review of infants <1 year of age presenting to a pediatric emergency department. Our primary outcome variable was consideration of abuse. Our secondary outcome measures were identification of predictor variables associated with consideration of abuse. We identified 509 infants meeting study criteria. Pediatric emergency physicians considered abuse in approximately two thirds of infants with fractures. Consideration was more likely to occur in younger infants, in the presence of no history or unwitnessed injury mechanism, when evaluated by male physicians, and emergency department encounters from 12 am to 6 am.

A Scoping Review of Current Social Emergency Medicine Research

“…Nineteen (26%) studies focused specifically on injury patterns of abused children, and the likelihood of child abuse among patients presenting with fractures, head trauma, and oral injuries. 71 , 75 , 81 , 82 , 86 , 91 , 95 , 97 , 99 , 101 , 107 , 109 – 111 , 113 , 115 , 117 , 119 , 127 About 22 (31%) studies focused specifically on child sexual assault cases, 70 , 79 , 80 , 96 , 98 , 106 , 112 , 116 , 118 , 120 , 123 , 125 , 130 , 132 , 133 , 141 with six of these studies looking at sexually transmitted infection (STI) and pregnancy testing, STI prophylaxis, and the use of sexual assault nurse examiners. 77 , 78 , 121 , 122 , 140 , 150 Two of three review publications focused on screening, 154 , 155 with one publication focusing on improving the ED workflow for suspected or confirmed child abuse cases.…”

Evidence From the USPSTF and New Approaches to Evaluate Interventions to Prevent Child Maltreatment

“…Second, future research could consider the drivers of, interventions for, and consequences of racial and ethnic bias in addressing child maltreatment. Such research could expand on work previously done in this area …”

Notificações de maus-tratos em um hospital infantil: Avaliação do perfil epidemiológico e sua relação com o desfecho em fraturas

“…3,6,7,19 The diagnosis of violence in the health sector 1,2,6,7,19 and notification to the responsible bodies avoids worse outcomes, such as emotional and physical sequelae and even death, especially in cases in which the victim suffers several aggressions over time in a chronic form. 1,6,7,10,11,[19][20][21][22][23] Whereas neglect is the most frequent type of child abuse, 2,3,7,11,23,24 it is observed that the incidence of injuries…”

“…O diagnóstico da violência no setor saúde 1 2 6 7 19 e a notificação aos órgãos responsáveis evitam piores desfechos, como sequelas emocionais, físicas e até óbito, principalmente em casos nos quais a vítima sofre diversas agressões ao longo do tempo de forma crônica. 1 6 7 10 11 19 20 21 22 23 Considerando que a negligência é o tipo mais frequente de maus-tratos infantis, 2 3 7 11 23 24 observa-se que a incidência de lesões nesses casos pode ser reduzida por meio da abordagem preventiva junto aos pais, orientando evitar cenários propensos a acidentes, incluindo os típicos de cada idade. 2 6 7 19…”

“…The diagnosis of violence in the health sector 1 2 6 7 19 and notification to the responsible bodies avoids worse outcomes, such as emotional and physical sequelae and even death, especially in cases in which the victim suffers several aggressions over time in a chronic form. 1 6 7 10 11 19 20 21 22 23 Whereas neglect is the most frequent type of child abuse, 2 3 7 11 23 24 it is observed that the incidence of injuries in these cases can be reduced through a preventive approach with parents, guiding them to avoid accident-prone scenarios, including those typical of each age. 2 6 7 19…”