Prevalence of Abuse Among Young Children With Rib Fractures

Abstract

Objectives We aimed to estimate the prevalence of abuse in young children presenting with rib fractures and to identify demographic, injury, and presentation-related characteristics that affect the probability that rib fractures are secondary to abuse. Methods We searched PubMed/MEDLINE and CINAHL databases for articles published in English between January 1, 1990 and June 30, 2014 on rib fracture etiology in children ≤ 5 years old. Two reviewers independently extracted predefined data elements and assigned quality ratings to included studies. Study-specific abuse prevalences and the sensitivities, specificities, and positive and negative likelihood ratios of patients’ demographic and clinical characteristics for abuse were calculated with 95% confidence intervals. Results Data for 1,396 children ≤ 48 months old with rib fractures were abstracted from 10 articles. Among infants < 12 months old, abuse prevalence ranged from 67% to 84%, whereas children 12-23 months old and 24-35 months old had study-specific abuse prevalences of 29% and 28% respectively. Age < 12 months was the only characteristic significantly associated with increased likelihood of abuse across multiple studies. Rib fracture location was not associated with likelihood of abuse. The retrospective design of the included studies and variations in ascertainment of cases, inclusion/exclusion criteria, and child abuse assessments prevented further meta-analysis. Conclusions Abuse is the most common cause of rib fractures in infants < 12 months old. Prospective studies with standardized methods are needed to improve accuracy in determining abuse prevalence among children with rib fractures and characteristics associated with abusive rib fractures.

A Bibliometric Analysis of the Global Research Trend in Child Maltreatment

“…Additionally, it reflects that awareness of child abuse is on the rise. However, some reports showed that the trend of child abuse was “not a true increase in prevalence but due to the changes in legislation” [ 25 , 26 ]. In another context, some researchers found that there were no changes in the rate of child physical abuse [ 27 , 28 ], even though there was a rise in the prevalence of child emotional abuse [ 28 ].…”

The role of the forensic anthropologist in the pediatric autopsy: Interpretations, contributions, and challenges

“…The presence of rib fractures in the absence of a known traumatic event, pathological condition, or pertinent history, are considered highly suspicious of pediatric NAI. While no specific rib fracture number or location is pathognomonic for abuse, the general consensus in the clinical realm has been that posterior or posteromedial rib fractures are highly specific for abuse (Kleinman, 2015; Love et al, 2011; Paine, Fakeye, Christian, & Wood, 2019). However, a recent review study by Paine et al (2019) argues that for children younger than 4 years old, there is not enough current literature to support the argument that posterior rib fractures, compared to rib fractures in other locations, indicate an increased likelihood of abuse (Paine et al, 2019).…”

Medical diagnoses among infants at entry in out‐of‐home care: A Swedish population‐register study

“…1,8,11,30,31,33 Only specific diagnoses of abuse, or adverse social and parental circumstances preceding the date of first entry in the Out-of-home Care Register or within 15 days after that date, were categorized as exposure variables. Diagnoses of SDH, RH, rib fracture, or long bone fracture were selected that are claimed to have the highest positive predicative value for abuse, PPV of 0.69 for SDH, 9 0.97 for severe RH, 9 0.67 to 1.0 for rib fracture, 10,15,34 and 0.57 for long bone fracture. 11 Those diagnoses were combined in different categories and finally as one category, "SDH, RH, rib fracture, or long bone fracture" ( Table 1).…”