The risk of child abuse in infants and toddlers with lower extremity injuries

Presented at the 35th Annual Meeting of the American Pediatric Surgical Association, Ponte Vedra, Florida, May 27-30, 2004.
https://doi.org/10.1016/j.jpedsurg.2004.09.003Get rights and content

Abstract

Purpose

The aim of this study was to assess the risk of child abuse in children younger than 18 months admitted to a pediatric trauma service with lower extremity injuries.

Methods

An Institutional Review Board–approved retrospective case series of children admitted to a regional pediatric trauma center with lower extremity injuries from 1998 to 2002 (n = 5497) was performed. Factors analyzed included age, injuries, and injury mechanism.

Results

Among 5497 trauma patients, the incidence of abuse was 104 (2%) of 4942 children 18 months or older and 175(32%) of 555 children younger than 18 months (odds ratio [OR], 21.4 ± 2.9, P < .001). There were 1252 (23%) patients with lower extremity injuries in the entire sample, and 66 of these were younger than 18 months. In the extremity trauma group, for patients 18 months or older, 16 (1%) of 1186 were abused compared with 44 (67%) of 66 patients younger than 18 months (OR, 146 ± 53, P < .001). Among all trauma patients younger than 18 months, 41 of 55 lower extremity fractures were linked to abuse, whereas 134 of 500 other injuries were caused by abuse (OR, 8.0 ± 2.6, P < .001). Among the 41 abuse-related fractures, femur fracture was the most common (22), followed by tibia fracture (14).

Conclusions

Among children 18 months or older, abuse is an uncommon cause of lower extremity trauma. In children younger than 18 months, lower extremity injuries, particularly fractures, are highly associated with child abuse. Clinicians must thoroughly investigate lower extremity injuries in this age group.

Section snippets

Methods

An Institutional Review Board–approved retrospective review of hospital-based trauma registry data was conducted to identify children with lower extremity injuries admitted to an American College of Surgeons–verified level I pediatric trauma center for 5 years (from 1998 through 2002 inclusive). After preliminary review of the population for age, cause of injury, and diagnoses, the group was further divided into 2 age groups for comparison: children younger than 18 months and children 18 months

Results

The study group consisted of 5497 patients admitted for treatment of injury during the time frame of the study. In the study group, 4942 (90%) children were 18 months or older and 555 (10%) were younger than 18 months old. The incidence of child abuse was 104 (2%) of 4942 children 18 months or older and 175 (32%) of 555 children younger than 18 months (OR, 21.4 ± 2.9, P < .001).

There were 1252 patients with lower extremity injuries in the entire study group. Sixty-six of these patients were

Discussion

The importance of recognizing abusive head trauma, which may masquerade as a variety of illnesses, has been emphasized by numerous studies [3], [4], [5]. However, when a child presents for treatment of lower extremity trauma, the diagnosis of abusive injury might seem to be more straightforward, as only rare medical conditions mimic lower extremity trauma [6]. Nevertheless, terms such as “toddler's fracture,” which is “typically a hairline, oblique fracture of the shaft of the tibia”[7], and

References (10)

  • Homicide and injury deaths and rates per 100,000. National Center for Injury Prevention and Control

  • K.A. Collins et al.

    A decade of pediatric homicide: a retrospective study at the Medical University of South Carolina

    Am. J. Forensic. Med. Pathol.

    (1999)
  • C. Jenny et al.

    Analysis of missed cases of abusive head trauma

    JAMA

    (1999)
  • R.L. Altman et al.

    Abusive head injury as a cause of apparent life-threatening events in infancy

    Arch. Pediatr. Adolesc. Med.

    (2003)
  • D.A. Listman et al.

    Accidental and abusive head injury in young children

    Curr. Opin. Pediatr.

    (2003)
There are more references available in the full text version of this article.

Cited by (56)

  • Trauma

    2019, A Practice of Anesthesia for Infants and Children
  • Trauma

    2018, A Practice of Anesthesia for Infants and Children
  • Femur fracture biomechanics and morphology associated with torsional and bending loading conditions in an in vitro immature porcine model

    2017, Journal of Forensic and Legal Medicine
    Citation Excerpt :

    Fractures are a common presentation of physical child abuse, occurring in nearly a third of child abuse cases.1–3 Femur fractures are particularly concerning, accounting for up to 50% of all fractures in child abuse.4–10 In young, non-ambulating children, fractures are strong indicators of abuse; studies have reported between 30% and 50% of femur fractures in non-ambulating children or those in early ambulating stages are due to abuse.11–13

  • Prevalence of Retinal Hemorrhages in Infants Presenting with Isolated Long Bone Fractures and Evaluation for Abuse

    2016, Journal of Emergency Medicine
    Citation Excerpt :

    In addition, this study did not collect data on whether the treating providers determined the fractures to be from abuse. The likelihood that many of the children were abused was high, as it has been reported 35–75% of femur fractures, 54–100% of humerus fractures, and 40–96% of tibia/fibula fractures are concerning for abuse in children < 12 to 18 months (25–32). Finally, despite a 10-year time period, the number of subjects in the final analysis is relatively small.

View all citing articles on Scopus
View full text