title: The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children.
abstract: BACKGROUND
  Rib fractures have a strong association with nonaccidental trauma (NAT) and severe trauma. The purposes of this study were to evaluate rib fractures in children to determine (1) the positive predictive value of a rib fracture in defining NAT and (2) the frequency of rib fractures as the only skeletal manifestation of NAT.
  
  
  METHODS
  We reviewed the medical records and imaging of all children with rib fractures over a 6-year period. NAT was determined by the Child Advocacy and Protection team.
  
  
  RESULTS
  In children younger than 3 years of age, the positive predictive value (PPV) of a rib fracture as an indicator of NAT was 95%. The positive predictive value increased to 100% once historical and clinical circumstance excluded all other causes for rib fractures.
  
  
  CONCLUSIONS
  In this study, rib fracture(s) were the only skeletal manifestation of NAT in 29% of the children.
authors.affiliation: Department of Surgery, The Children's Hospital, University of Colorado Health Sciences Center, Denver, USA. katherine.barsness@uchsc.edu
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Barsness
authors.forename: Eun-Suk
authors.initials: ES
authors.lastname: Cha
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
authors.forename: Casey M
authors.initials: CM
authors.lastname: Calkins
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Karrer
authors.forename: John D
authors.initials: JD
authors.lastname: Strain
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014193:Trauma Centers / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000453:epidemiology