The epidemiology of nonaccidental trauma in children.
BACKGROUND
Abuse of children is abhorrent in Western society and, yet, is not uncommon. Nonaccidental trauma (NAT) is the result of a complex sociopathology. Not all of the causative factors of NAT are known, many are incompletely described, not all function in each case, and many are secondary to preexisting pathology in other areas.


OBJECTIVE
We therefore addressed the following questions in this review: (1) what is the general incidence of NAT; (2) what factors are intrinsic to the abused child, family, and society; and (3) what orthopaedic injuries are common in NAT?


METHODS
We searched Medline, Medline In Process & Other Non-Indexed Citations, and Embase using OVID. Only one article fit our inclusion criteria; therefore, this is a descriptive generalized review of the epidemiology of NAT.


RESULTS
The general incidence of NAT ranges from 0.47 per 100,000 to 2000 per 100,000. Younger children are at greater risk of NAT than older children. Parents are often the perpetrators of the abuse. Rib fractures are highly indicative of NAT in young children.


CONCLUSIONS
It is important to consider child, family, and societal factors when confronted with suspicions of child abuse. Our review demonstrates the currently limited information on the true incidence of NAT. To determine a much more accurate incidence of NAT, there needs to be a population-based surveillance program conducted through primary care providers.
Mulpuri
Kishore
K
Department of Orthopaedics, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada. kmulpuri@cw.bc.ca
Slobogean
Bronwyn L
BL
Tredwell
Stephen J
SJ
D000059:Accidents; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data*; D002675:Child, Preschool; D019548:Crime Victims; D006801:Humans; D015994:Incidence; D007223:Infant; D012253:Rib Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012931:Social Environment; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology*