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
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