title: Are abusive fractures in young children becoming less common? Changes over 24 years.
abstract: OBJECTIVE
  To determine whether the proportion of fractures rated as abusive in children <36 months of age evaluated at a regional pediatric hospital increased over a 24-year period from 1979 to 2002. Fractures were chosen as an example of serious injuries in young children.
  
  
  METHODS
  Medical records were abstracted for all children <36 months of age who were seen at a single pediatric hospital with a fracture during three time periods: 1979-1983, 1991-1994, and 1999-2002. After reviewing the abstracted and radiographic information, two clinicians (one an expert on child abuse) and two pediatric radiologists each rated the likelihood of abuse using explicit criteria and a seven-point scale from definite abuse to definite unintentional injury. Ratings were done independently; when disagreements occurred, the case was discussed, and a joint rating was agreed upon, if possible. The proportions of cases rated as abuse were compared over the three time periods, and logistic regression was used to calculate adjusted odds ratios (OR).
  
  
  RESULTS
  In the early, middle, and late samples, there were 200, 240, and 232 children, respectively, with fractures. The proportion of cases rated as abuse decreased from 22.5% in the early period to 10.0% in the middle period and was 10.8% in the late period (p<.001). When comparing the odds of abuse in the middle and late groups to the odds of abuse in the early group (controlling for age, gender, ethnicity, type of medical insurance, and site of pediatric care), the adjusted ORs were .31 (95% CI=.15, .62) for the middle group and .45 (95% CI=.23, .86) for the late group. Thus, the odds of a given case being rated as abuse decreased by over 50% from the early period to the middle and late time periods. No statistically significant difference was found when comparing the odds of abuse for the middle group to those of the late group, OR: 1.46 (95% CI=.69, 3.08).
  
  
  CONCLUSIONS
  The proportion of abusive fractures in young children decreased substantially from 1979-1983 to 1991-1994 and 1999-2002 at a major pediatric hospital. We speculate that this decrease may reflect early recognition of less serious forms of maltreatment and the availability of services to high-risk families.
authors: Department of Pediatrics, Yale University School of Medicine, P.O. Box 208064, 333 Cedar Street, New Haven, CT 06520-8064, USA.
authors: John M
authors: JM
authors: Leventhal
authors: Ilse A
authors: IA
authors: Larson
authors: Denise
authors: D
authors: Abdoo
authors: Sujatha
authors: S
authors: Singaracharlu
authors: Carolina
authors: C
authors: Takizawa
authors: Cindy
authors: C
authors: Miller
authors: T R
authors: TR
authors: Goodman
authors: Dana
authors: D
authors: Schwartz
authors: Susanne
authors: S
authors: Grasso
authors: Katherine
authors: K
authors: Ellingson
mesh_terms: D000367:Age Factors; D001497:Battered Child Syndrome / Q000453:epidemiology; D002649:Child Abuse / Q000639:trends*; D002675:Child, Preschool; D003237:Connecticut; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors