title: The risk of child abuse in infants and toddlers with lower extremity injuries.
abstract: OBJECTIVE
  The aim of this study was to assess the risk of child abuse in children younger than 18 months admitted to a pediatric trauma service with lower extremity injuries.
  
  
  METHODS
  An Institutional Review Board-approved retrospective case series of children admitted to a regional pediatric trauma center with lower extremity injuries from 1998 to 2002 (n = 5497) was performed. Factors analyzed included age, injuries, and injury mechanism.
  
  
  RESULTS
  Among 5497 trauma patients, the incidence of abuse was 104 (2%) of 4942 children 18 months or older and 175(32%) of 555 children younger than 18 months (odds ratio [OR], 21.4 +/- 2.9, P < .001). There were 1252 (23%) patients with lower extremity injuries in the entire sample, and 66 of these were younger than 18 months. In the extremity trauma group, for patients 18 months or older, 16 (1%) of 1186 were abused compared with 44 (67%) of 66 patients younger than 18 months (OR, 146 +/- 53, P < .001). Among all trauma patients younger than 18 months, 41 of 55 lower extremity fractures were linked to abuse, whereas 134 of 500 other injuries were caused by abuse (OR, 8.0 +/- 2.6, P < .001). Among the 41 abuse-related fractures, femur fracture was the most common (22), followed by tibia fracture (14).
  
  
  CONCLUSIONS
  Among children 18 months or older, abuse is an uncommon cause of lower extremity trauma. In children younger than 18 months, lower extremity injuries, particularly fractures, are highly associated with child abuse. Clinicians must thoroughly investigate lower extremity injuries in this age group.
authors.affiliation: The Trauma Program, Children's Hospital, Columbus, OH 43205, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Coffey
authors.forename: Kathy
authors.initials: K
authors.lastname: Haley
authors.forename: John
authors.initials: J
authors.lastname: Hayes
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Groner
mesh_terms: D002649:Child Abuse / Q000706:statistics & numerical data*; D005264:Femoral Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D035002:Lower Extremity / Q000293:injuries*; D009820:Ohio; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D013978:Tibial Fractures / Q000453:epidemiology*; D014193:Trauma Centers