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Non-accidental fractures in infants: risk of further abuse.

Published on Dec 1, 2000in Journal of Paediatrics and Child Health1.688
· DOI :10.1046/j.1440-1754.2000.00592.x
C Y Skellern1
Estimated H-index: 1
(Boston Children's Hospital),
D O Wood1
Estimated H-index: 1
(Boston Children's Hospital)
+ 1 AuthorsMatthew Crawford5
Estimated H-index: 5
(Boston Children's Hospital)
Abstract
the exact risk of further abuse in the subgroup ofinfants aged under 12 months presenting with a fracture alonehas not been defined.In this study, the characteristics of non-accidental fracturesin infants and the features which distinguish accidental fromnon-accidental fractures are described. Furthermore, the risk ofsubsequent abuse in infants sustaining a non-accidentalfracture is clarified.METHODSThe records of all children aged under 1 year with a fracturewho presented to the Mater Children’s Hospital betweenJanuary 1990 and December 1993 were retrieved. These sub-jects were identified on the basis of diagnosis at hospitalseparation and notification to an ongoing study of childhoodtrauma called the Queensland Injury Surveillance and Preven-tion Project (QISPP). Data for QISPP was collected, withparental consent, on presentation to the Emergency Depart-ment of the Mater Children’s Hospital; children with inci-dental findings of a fracture on skeletal survey in the contextof other major injuries were excluded.Following a retrospective review of medical records thecohort of infants was divided into two groups: (i) those withsuspected accidental fractures, and (ii) those with suspectednon-accidental fractures. Subjects were classified as non-accidental if medical staff were alerted by historical or radio-logical findings, and child protection medical staff concurredon further assessment. Factors considered in this decisionwere: if (i) an admission was made that the injuries had beendeliberately inflicted; (ii) the injuries were not compatible withthe clinical history; (iii) historical account of the injury varied;(iv) there was a lack of any explanation for injuries; (v) therewere accompanying physical signs of abuse or neglect suchas bruises, burns, nutritional deprivation; (vi) the fracture-typehad a high specificity for child abuse, e.g. rib and metaphysealfractures; and (vii) other fractures were detected on skeletalsurvey. All those cases classified as suspected non-accidentalwere referred under mandatory notification to a multiagencySuspected Child Abuse and Neglect (SCAN) team (consistingof police, Department of Families,Youth and Community Care(DFYCC), and health representation) for further assessmentand management. Subjects were classified into the accidentalgroup if medical officers in the emergency department orJ. Paediatr. Child Health (2000) 36, 590–592
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The objective of this postmortem study was to use high-detail skeletal surveys, specimen radiography, and histopathologic analysis to determine the number, distribution, and age of inflicted skeletal injuries in infants studied at the University of Massachusetts Medical Center from 1984 to 1994.Thirty-one infants (average age, 3 months) who died with inflicted skeletal injuries were studied with high-detail skeletal surveys and specimen radiography and histopathologic analysis. The distribution ...
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#1Patrick J. McMahon (University of Pittsburgh)H-Index: 23
#2W. Grossman (University of Pittsburgh)H-Index: 1
Last. C. Stanitski (University of Pittsburgh)H-Index: 1
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We reviewed the hospital records of 371 children who were suspected of having been physically abused. Our purpose was to determine specific features that might be used to distinguish injuries resulting from abuse from accidental injuries. Soft-tissue injuries were found in 341 (92 per cent) of these children. Ecchymoses were most common, accounting for 555 (62 per cent) of 892 soft-tissue injuries, and very few had a suspicious pattern. Only thirty-four (9 per cent) of the children had a radiogr...
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Caffey’s paper on the association between fractures of the long bones and subdural haematoma, published in 1946, was the first modern description of the consequences of child abuse, now often referred to by the euphemism ‘non-accidental injury’. Since then there have been many reports of the skeletal injuries in the radiological and paediatric literature (Caffey 1957; Kempe et al 1962; Griffiths and Moynihan 1963; Silverman 1972; Merten, Radkowski and Leonidas 1983; Ellerstein and Norris 1984; C...
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#1John M. LeventhalH-Index: 45
#2Susan A. ThomasH-Index: 3
Last. Richard I. MarkowitzH-Index: 22
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• Objective. —To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries. Design. —Case series. Setting. —Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center). Patients. —Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse regi...
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#1Areta Kowal-Vern (Loyola University Medical Center)H-Index: 21
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One hundred twenty-four urban children under 3 years of age admitted for fractures were retrospectively reviewed to determine the frequency of accidental and nonaccidental causes in this population. The fractures were categorized according to their mechanisms: motor-vehicle passenger or pedestrian accident, other accidents, or child abuse. There were no differences in the frequency of fractures by race, date of birth, or season in which the injury occurred. Skull fractures were most frequent (62...
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#1Gail M. StewartH-Index: 9
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We evaluated the characteristics of traumatic injury and risk for subsequent trauma in infants less than three months of age (n = 111). Medical records were reviewed at presentation and one year later. Injury was due to abuse/neglect in 28%, whereas 72% were accidentally injured. Falls were the most common mechanism of accidental injury (67%). The percentage of infants with skull fractures was greater in the abuse/neglect group than in the accidental group (7/31 vs 7/80; P Language: en
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OBJECTIVE: To assess the effectiveness of a child abuse surveillance and intervention program in protecting infants at risk. DESIGN AND SETTING: A retrospective review of all children discussed by the Suspected Child Abuse and Neglect Team of the Mater Misericordiae Children's Hospital, South Brisbane, over the five year period January 1986 to December 1990. PATIENTS: A total of 2126 children were discussed by the team; 375 were infants (less than 12 months of age) at the time of the initial dis...
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The incidence and pattern of fractures in children who had been abused were compared with those of fractures sustained by children of similar ages in whom abuse had been excluded. From 1976 to 1982 there were 35 children with fractures resulting from child abuse, and all were aged under 5. Of the 826 children in the control group, seen from January to June 1981, 85% were aged over 5. Abused children were much more likely to have multiple fractures (p less than 0.001) and bruising of the head and...
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The diagnosis of child abuse is contingent upon having a high index of suspicion. Orthopedic surgeons and other surgical specialists should be more involved in a team approach for prevention, detection and management in cases of child abuse in the hope of breaking the cycle of this mutilating and often fatal tragedy. Language: en
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Die Behandlungsprinzipien von Frakturen beim Kind richten sich nach den besonderen Eigenschaften der Frakturheilung am wachsenden Skelett. Das Skelett des Kindes stellt ein vom Alter abhangiges dynamisch wachsendes Organ dar, mit der Fahigkeit, schnell knocherne Verletzungen zu heilen, mit hoher Toleranz gegen Weichteilverletzung, geringen Immobilitatsschaden und altersabhangig moglicher Korrektur von posttraumatische Fehlstellungen. Diese Fahigkeiten sind am Skelett des Kindes nicht uberall gle...
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Approximately one fourths of infant fractures are due to abuse. Recognition of abuse is important to avoid further morbidity/mortality. There is limited knowledge regarding how frequently pediatric...
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AIM & OBJECTIVES: To explore paediatric nurses' views of caring for infants who have suffered non-accidental injury. BACKGROUND: Children less than 2 years of age are at greater risk of serious abuse than those in any other age group. An infants' physical and mental immaturity makes them especially vulnerable. Abuse in this age group is often caused by a parent who does not report the abuse. The experience of caring for abused children is recognised as being both personally and professionally ch...
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Recognising the skeletal manifestations of inflicted injury (II) in infants and young children is of crucial importance. There are specific fracture patterns which are highly suspicious of II in addition to common differential diagnoses with which radiologists should be familiar. Our objective is to provide a non-exhaustive review of the important factors relevant to the imaging and reporting of II as a platform for further learning. Part 1 encompasses important initial considerations and fractu...
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Purpose To create a timetable for dating long bone fractures in infants aged less than 1 year using previously defined radiographic signs of fracture healing.
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The study examined whether the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition (DC: 0-3R; ZERO TO THREE, 2005) Parent-Infant Relationship Global Assessment Scale (PIR-GAS) is applicable to six European countries and contributes to the identification of caregiver-infant/toddler dyads with abusive relationship patterns. The sample consisted of 115 dyads with children's ages ranging from 1 to 47 months. Sixty-four dyads were rec...
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