title: Incidence of fractures among children with burns with concern regarding abuse.
abstract: OBJECTIVE
  Consensus recommendations state that a radiographic skeletal survey is mandatory for all children <2 years of age with concern for physical abuse. It has been suggested that patients with burns may represent a special subgroup at lower risk for occult fractures, compared with other abused children. Our objective was to determine the prevalence of fractures in children referred for subspecialty abuse evaluations because of burns.
  
  
  METHODS
  We performed retrospective analyses of data collected as part of the Using Liver Transaminases to Recognize Abuse (ULTRA) research network. Data were collected for all children <5 years of age who were referred to 19 child protection teams for subspecialty child abuse evaluations over 1 year (N = 1676). We compared the rate of fractures in children presenting with burns with that in other children evaluated for abuse.
  
  
  RESULTS
  Of 97 children <24 months of age with burns, 18 (18.6%) were also found to have fractures. Among all 1203 children <24 months of age, 649 (53.9%) had fractures. Eleven children had multiple fractures, and 12 children had fractures with radiographic evidence of healing. Two children were noted to have classic metaphyseal fractures.
  
  
  CONCLUSIONS
  The rate of fractures in children who present with burns and concerns regarding physical abuse is sufficient to support the recommendation for routinely performing skeletal surveys for children <2 years of age.
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, 75 Francis St, Neville House, Boston, MA 02115, USA.
authors.forename: Marcus
authors.initials: M
authors.lastname: Degraw
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Hicks
authors.forename: Daniel
authors.initials: D
authors.lastname: Lindberg
mesh_terms: D017677:Age Distribution; D001842:Bone and Bones / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000453:epidemiology; D002056:Burns / Q000453:epidemiology*; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D003288:Contusions / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies