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What Fracture at What Age Means Abuse?

October 29, 2020

Written by Clay Smith

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Children <3 years with a rib fracture or <18 months with a humerus or femur fracture need further workup for abuse.

Why does this matter?
Children have bumps and bruises. But it’s important to recognize which injuries are from abuse. If unrecognized, the risk of recurrent abuse or death is high. One way to help us overcome racial or socioeconomic biases is to have standard criteria for when to pursue comprehensive abuse workup. This study helps us sort this out.

Better check it out…
This was a scoping review that found 15 studies to answer key questions about what fractures and age ranges should receive routine additional workup for possible abuse. An expert panel decided on recommendations for each type of fracture based on literature review. All of them excluded verified incidents, such as a car crash or accident occurring in public. There were too few studies to assess forearm, hand, lower leg, and foot fractures. Here are the conclusions.

  • It is strongly recommended that children <3 years with a rib fracture (or fractures) routinely undergo full child abuse evaluation.

  • It is strongly recommended that children <18 months with either humeral or femoral fractures routinely undergo full child abuse evaluation. Supracondylar humerus fractures should likely be excluded.

Child abuse evaluation may include social work consultation, reporting to child protective services, involvement of a clinical team with expertise in forensic interview and exam, and additional lab and imaging evaluation.

Identifying Maltreatment in Infants and Young Children Presenting with Fractures: Does Age Matter?. Acad Emerg Med. 2020 Sep 5. doi: 10.1111/acem.14122. Online ahead of print.

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