Fractures in young children. Distinguishing child abuse from unintentional injuries.
OBJECTIVE
To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries.


METHODS
Case series.


METHODS
Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center).


METHODS
Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse registry.


METHODS
Each case was rated, by means of predefined criteria and a consensus of two clinicians and two pediatric radiologists, on a seven-point scale from "definite child abuse" to "definite unintentional injury." A middle rating of "unknown" was used if there was not enough information to reach a consensus.


RESULTS
Of the 253 fractures in 215 children that were identified, we categorized 24.2% as abuse, 8.4% as unknown, and 67.4% as unintentional injuries. Fractures that were considered likely due to abuse were (1) fractures in children whose caretakers reported either a change in the child's behavior, but no accidental event, or a minor fall, but the injury was more severe than expected; (2) fractures of the radius/ulna, tibia/fibula, or femur in children less than 1 year of age; or (3) midshaft or metaphyseal fractures of the humerus. Linear fractures of the parietal bone were the most common skull fractures, whether due to abuse or unintentional injuries.


CONCLUSIONS
In young children with fractures, child abuse is common. By comparing fractures due to abuse and those due to unintentional injuries, we obtained empiric evidence to help clinicians and radiologists correctly examine children with such serious injuries.
Leventhal
J M
JM
Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. 06510.
Thomas
S A
SA
Rosenfield
N S
NS
Markowitz
R I
RI
D000058:Accidental Falls / Q000706:statistics & numerical data*; D015984:Causality; D002649:Child Abuse / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008487:Medical History Taking; D044469:Racial Groups; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies