Prevalence of abusive injuries in siblings and household contacts of physically abused children.
OBJECTIVE
Siblings and other children who share a home with a physically abused child are thought to be at high risk for abuse, but rates of injury in these contact children are unknown and screening of contacts is highly variable. Our objective was to determine the prevalence of abusive injuries identified by a common screening protocol among contacts of physically abused children.


METHODS
This is an observational, multicenter cross-sectional study of children evaluated for physical abuse, and their contacts, by 20 US child abuse teams who used a common screening protocol for the contacts of physically abused children with serious injuries. Contacts underwent physical examination if they were <5 years old, physical examination and skeletal survey (SS) if they were <24 months old, and physical examination, SS, and neuroimaging if they were <6 months old.


RESULTS
Protocol-indicated SS identified at least 1 abusive fracture in 16 of 134 contacts (11.9%, 95% confidence interval [CI] 7.5-18.5) <24 months of age. None of these fractures had associated findings on physical examination. No injuries were identified by neuroimaging in 19 of 25 eligible contacts (0.0%, 95% CI 0.0-13.7). Twins were at substantially increased risk of fracture relative to nontwin contacts (odds ratio 20.1, 95% CI 5.8-69.9).


CONCLUSIONS
SS should be obtained in the contacts of injured, abused children for contacts who are <24 months old, regardless of physical examination findings. Twins are at higher risk of abusive fractures relative to nontwin contacts.
Department of Emergency Medicine, Brigham & Women's Hospital, 75 Francis St-Neville House, Boston, MA 02132, USA. dlindberg@partners.org
Daniel M
DM
Lindberg
Robert A
RA
Shapiro
Antoinette L
AL
Laskey
Daniel J
DJ
Pallin
Emily A
EA
Blood
Rachel P
RP
Berger
D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D017579:Domestic Violence / Q000523:psychology / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D016017:Odds Ratio; D011678:Punishment; D012307:Risk Factors; D012737:Sex Factors; D035781:Siblings; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000523:psychology