2009 Annual Meeting Podium Presentations

Pediatrics 2: Upper and Lower Extremity, Trauma

Child Abuse and Orthopaedic Injury Patterns: Analysis at a Level I Pediatric Trauma Center

Podium No: 587

Friday, February 27, 2009
01:36 PM - 01:42 PM

Location: Venetian Hotel
Room 3105

Nirav Kiritkumar Pandya, MD Philadelphia PA
Keith D Baldwin, MD Philadelphia PA
Harish Sadanand Hosalkar, MD San Diego CA
Hayley Wolfgruber New York NY
Cindy W Christian, MD
Denis S Drummond, MD Philadelphia PA

Moderator(s):
Gregory A Mencio, MD Nashville TN
Susan A Scherl, MD Omaha NE

For patients who present to pediatric trauma centers, it is important for the clinician to recognize that patient age and fracture type are important for identifying potential child abuse.

The purpose of our study was to describe the patterns of orthopaedic injury for child abuse cases detected in the large urban area that our institution serves, and to compare the injury profiles of these victims of child abuse to that of general (accidental) trauma patients seen in the emergency room and/or hospitalized during the same time period.

This study is a retrospective review of prospectively collected information from an urban level I pediatric trauma center. Five hundred cases of child abuse (ages birth to 48 months) were identified by membership in our institution's Suspected Child Abuse and Neglect (SCAN) database collected between 1998 to 2007. These cases were compared against 985 general trauma (accidental) control patients of the same age group from 2000 to 2003. Age, gender, and injury type were compared.

Victims of child abuse were on average younger than accidental trauma patients in the cohort of patients under 48 months of age. There was no difference in gender distribution between child abuse and accidental trauma patients. When the entire cohort of patients under 48 months were examined after adjusting for age and gender, the odds of rib (14.4 times), tibia/fibula (6.3 times), radius/ulna (5.8 times), clavicle (4.4 times), and foot fractures (3.6 times) were significantly higher in child abuse versus accidental trauma patients. When re-grouping the data based on age, in patients younger than 18 months of age, the odds of rib (23.7 times), tibia/fibula (12.8 times), humerus (2.3 times), and femur fractures (1.8 times) was found to be significantly higher in the child abuse group. Yet, in the over 18 month age group, the risk of humerus (3.6 times) and femur fractures (3.3 times) was actually higher in the accidental trauma group than in the child abuse group, and tibia/fibula fractures could no longer be used to differentiate abuse from accidental trauma.

Patients who present to an urban level I pediatric trauma centers who are victims of abuse are generally younger, and have an equal propensity to be male or female. It is important for the clinician to recognize that the age of the patient (younger or older than 18 months and/or walking age) is an important determinant in identifying injury patterns suspicious for abuse. Patients below the age of 18 months who present with rib, tibia/fibula, humerus, or femur fractures are more likely to be victims of abuse than accidental trauma patients. Yet, when patients advance in age beyond 18 months, their presentation with long bone fractures excluding those of the tibia/fibula (i.e. femur and humerus) is more likely to be related to accidental trauma than child abuse.

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An alphabetical listing of disclosures will be available at a later time.

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