Can we increase detection? A nationwide analysis of age-related fractures in child abuse

Abstract

Purpose: The purpose of this study was to stratify fractures associated with child abuse in relation to the child's age.

Methods: The Kids' Inpatient Database (1997-2012) was queried for all patients (<18 years old) with a diagnosis of fracture and child abuse. The primary outcome was age-related determinants of fracture distribution. Chi-squared analysis was used for statistical analysis where appropriate, with significance set at p < 0.05.

Results: More than 39,000 children were admitted for child abuse, and 26% sustained fractures. Most were infants (median age 0 year [IQR 0-1]). 28% sustained multiple fractures, and 27% had skull fractures. By age, infants had the highest rate of multiple fractures (33% vs 16% 1-4 years), and the highest rate of closed skull fractures (33% vs 21% ages 1-4), while adolescents had more facial fractures (43% vs 11% ages 9-12), all p < 0.001. Multiple rib fractures were more commonly seen in infants (28% vs 8% ages 1-4), while children 5-8 years had the highest rates of clavicular fractures (7% vs 3% in infants), all p < 0.001.

Conclusion: Age-related fracture patterns exist and may be due to changing mechanism of abuse as a child grows. These age-related fracture patterns can help aid in healthcare detection of child abuse in hopes to thwart further abuse.

Type of study: Retrospective comparative study.

Level of evidence: Level III.

Keywords: Abuse patterns; Child abuse; Fractures.